Provider Demographics
NPI:1538125521
Name:ALLIED PHYSICIANS GROUP INC PC
Entity Type:Organization
Organization Name:ALLIED PHYSICIANS GROUP INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-495-5154
Mailing Address - Street 1:6820 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5217
Mailing Address - Country:US
Mailing Address - Phone:405-495-5154
Mailing Address - Fax:405-603-2313
Practice Address - Street 1:6824 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5217
Practice Address - Country:US
Practice Address - Phone:405-495-5154
Practice Address - Fax:405-603-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200031250BMedicaid
OK600522049OtherPROVIDER