Provider Demographics
NPI:1689949885
Name:A VAIL STEPHENS MD INC
Entity Type:Organization
Organization Name:A VAIL STEPHENS MD INC
Other - Org Name:A VAIL STEPHENS MD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-557-1200
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-1550
Mailing Address - Country:US
Mailing Address - Phone:405-361-9417
Mailing Address - Fax:405-348-2325
Practice Address - Street 1:1701 E 2ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6405
Practice Address - Country:US
Practice Address - Phone:405-348-2323
Practice Address - Fax:405-348-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty