Provider Demographics
NPI:1679917942
Name:MEDSTAFF PC
Entity Type:Organization
Organization Name:MEDSTAFF PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7431
Mailing Address - Street 1:4500 S 129TH EAST AVE
Mailing Address - Street 2:STE 191
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5801
Mailing Address - Country:US
Mailing Address - Phone:918-779-7900
Mailing Address - Fax:918-779-7425
Practice Address - Street 1:1 LEGGETT RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-9649
Practice Address - Country:US
Practice Address - Phone:417-237-6208
Practice Address - Fax:404-698-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty