Provider Demographics
NPI:1437533528
Name:BUFFALO COUNTRY MEDICAL, P.C.
Entity Type:Organization
Organization Name:BUFFALO COUNTRY MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSZKO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:469-766-5203
Mailing Address - Street 1:18 OAK AVENUE
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432
Mailing Address - Country:US
Mailing Address - Phone:469-766-5203
Mailing Address - Fax:
Practice Address - Street 1:1308 E CARL ALBERT PKWY # A
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5130
Practice Address - Country:US
Practice Address - Phone:469-766-5203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty