Provider Demographics
NPI:1558403931
Name:RENAISSANCE PHYSICIANS OF MIDWEST CITY LLC
Entity Type:Organization
Organization Name:RENAISSANCE PHYSICIANS OF MIDWEST CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-733-4985
Mailing Address - Street 1:1800 S DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6224
Mailing Address - Country:US
Mailing Address - Phone:405-733-4985
Mailing Address - Fax:405-737-4041
Practice Address - Street 1:1800 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6224
Practice Address - Country:US
Practice Address - Phone:405-733-4985
Practice Address - Fax:405-737-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty