Provider Demographics
NPI:1922189729
Name:MEDCOLOGY LLC
Entity Type:Organization
Organization Name:MEDCOLOGY LLC
Other - Org Name:BOULEVARD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:T DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-470-1884
Mailing Address - Street 1:PO BOX 22656
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73123-1656
Mailing Address - Country:US
Mailing Address - Phone:405-470-1884
Mailing Address - Fax:405-470-1028
Practice Address - Street 1:3431 S BOULEVARD ST
Practice Address - Street 2:SUITE 109
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5475
Practice Address - Country:US
Practice Address - Phone:405-562-1870
Practice Address - Fax:405-562-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service