Provider Demographics
NPI:1205884145
Name:TSG PHYSICIANS GROUP
Entity type:Organization
Organization Name:TSG PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-917-0300
Mailing Address - Street 1:PO BOX 12277
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2277
Mailing Address - Country:US
Mailing Address - Phone:405-917-0300
Mailing Address - Fax:405-917-0419
Practice Address - Street 1:2308B W HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-6729
Practice Address - Country:US
Practice Address - Phone:918-968-4469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN PLAINS MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200061890AMedicaid
OK200061890BMedicaid
OK200061890AMedicaid