Provider Demographics
NPI:1972668218
Name:AHS OKLAHOMA PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:AHS OKLAHOMA PHYSICIAN GROUP, LLC
Other - Org Name:CARL SMITH, DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-579-1000
Mailing Address - Street 1:1145 S UTICA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4000
Mailing Address - Country:US
Mailing Address - Phone:918-579-3825
Mailing Address - Fax:918-579-1262
Practice Address - Street 1:700 W 7TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2302
Practice Address - Country:US
Practice Address - Phone:918-367-4909
Practice Address - Fax:918-367-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty