Provider Demographics
NPI:1609016971
Name:AGILITY MEDICAL GROUP
Entity Type:Organization
Organization Name:AGILITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-2500
Mailing Address - Street 1:2236 NW 10TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-5658
Mailing Address - Country:US
Mailing Address - Phone:405-842-2500
Mailing Address - Fax:405-842-2509
Practice Address - Street 1:2236 NW 10TH ST STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5658
Practice Address - Country:US
Practice Address - Phone:405-842-2500
Practice Address - Fax:405-842-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies