Provider Demographics
NPI:1609003409
Name:OKLAHOMA ALGIATRY GROUP
Entity Type:Organization
Organization Name:OKLAHOMA ALGIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MANAGER/COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:405-509-6241
Mailing Address - Street 1:PO BOX 30635
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0011
Mailing Address - Country:US
Mailing Address - Phone:405-509-6241
Mailing Address - Fax:405-509-6242
Practice Address - Street 1:105 S BRYANT AVE STE 301
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6331
Practice Address - Country:US
Practice Address - Phone:405-509-6241
Practice Address - Fax:405-509-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK19307208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty