Provider Demographics
NPI:1760702153
Name:PREMIER HOSPITALISTS PC
Entity Type:Organization
Organization Name:PREMIER HOSPITALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-401-6334
Mailing Address - Street 1:13401 W SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-8565
Mailing Address - Country:US
Mailing Address - Phone:405-401-6334
Mailing Address - Fax:
Practice Address - Street 1:13401 W SIMMONS RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-8565
Practice Address - Country:US
Practice Address - Phone:405-401-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19384208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F66491Medicare UPIN
OKOKA101262Medicare PIN