Provider Demographics
NPI:1578928750
Name:ZOELLNER MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ZOELLNER MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HARGRAVE
Authorized Official - Last Name:ZOELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-289-4244
Mailing Address - Street 1:3020 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6138
Mailing Address - Country:US
Mailing Address - Phone:918-289-4244
Mailing Address - Fax:
Practice Address - Street 1:3020 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6138
Practice Address - Country:US
Practice Address - Phone:918-289-4244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care