Provider Demographics
NPI:1205474996
Name:UNIVERSITY HEIGHTS MEDICAL CLINIC
Entity type:Organization
Organization Name:UNIVERSITY HEIGHTS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYFORD
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:918-683-6500
Mailing Address - Street 1:2901 AZALEA PARK DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2283
Mailing Address - Country:US
Mailing Address - Phone:918-683-6500
Mailing Address - Fax:918-683-8665
Practice Address - Street 1:2901 AZALEA PARK DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2283
Practice Address - Country:US
Practice Address - Phone:918-683-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty