Provider Demographics
NPI:1760633846
Name:EVIDENT HEALTH SERVICES. LLC
Entity Type:Organization
Organization Name:EVIDENT HEALTH SERVICES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:405-713-4990
Mailing Address - Street 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:STE. 520
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4444
Mailing Address - Country:US
Mailing Address - Phone:405-713-4990
Mailing Address - Fax:
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:STE. 520
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4444
Practice Address - Country:US
Practice Address - Phone:405-713-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADRUGADA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20972207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty