Provider Demographics
NPI:1568777043
Name:GUY E. GROOMS, M.D., P.C.
Entity Type:Organization
Organization Name:GUY E. GROOMS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-682-7717
Mailing Address - Street 1:209 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5043
Mailing Address - Country:US
Mailing Address - Phone:918-682-7717
Mailing Address - Fax:918-682-9434
Practice Address - Street 1:209 S 36TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5043
Practice Address - Country:US
Practice Address - Phone:918-682-7717
Practice Address - Fax:918-682-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100213780AMedicaid
OKF03950Medicare UPIN
OK100213780AMedicaid
OK6330800001Medicare NSC