Provider Demographics
NPI:1508891789
Name:CARDIOLOGY SERVICES OF ENID
Entity Type:Organization
Organization Name:CARDIOLOGY SERVICES OF ENID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP RURAL PHYSICIAN PRACT MGMT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-548-1367
Mailing Address - Street 1:DEPT 960278
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0278
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1583
Practice Address - Street 1:707 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7286
Practice Address - Country:US
Practice Address - Phone:580-616-7630
Practice Address - Fax:580-237-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200106320AMedicaid
KS200608360AMedicaid
KS200608360AMedicaid
KS200608360AMedicaid
OK200106320AMedicaid
OKDF9672Medicare PIN