Provider Demographics
NPI:1851729461
Name:MEDSTAFFPC
Entity Type:Organization
Organization Name:MEDSTAFFPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7431
Mailing Address - Street 1:4500 S 129TH EAST AVE STE 191
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5891
Mailing Address - Country:US
Mailing Address - Phone:918-779-7400
Mailing Address - Fax:918-779-7425
Practice Address - Street 1:1114 DAVIS ST
Practice Address - Street 2:STE 126
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-4805
Practice Address - Country:US
Practice Address - Phone:713-534-8342
Practice Address - Fax:404-494-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty