Provider Demographics
NPI:1356124325
Name:OKLAHOMA VASCULAR AND EMBOLIZATION CENTER BY FLEX MEDICAL GROUP
Entity type:Organization
Organization Name:OKLAHOMA VASCULAR AND EMBOLIZATION CENTER BY FLEX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-768-5749
Mailing Address - Street 1:1145 W I 240 SERVICE RD STE F10
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2171
Mailing Address - Country:US
Mailing Address - Phone:405-768-5749
Mailing Address - Fax:405-708-7884
Practice Address - Street 1:8324 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-768-5749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty