Provider Demographics
NPI: | 1487643375 |
---|---|
Name: | MEDSTAR EMERGENCY PHYSICIANS PLLC |
Entity Type: | Organization |
Organization Name: | MEDSTAR EMERGENCY PHYSICIANS PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DIXIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GRANT-COLLINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 918-587-2561 |
Mailing Address - Street 1: | DEPT 672 |
Mailing Address - Street 2: | |
Mailing Address - City: | TULSA |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74127 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 866-321-8433 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 744 W 9TH ST |
Practice Address - Street 2: | |
Practice Address - City: | TULSA |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74127-9020 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-587-2561 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-10-14 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 207PE0004X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207PE0004X | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | Group - Multi-Specialty |