Provider Demographics
NPI:1396881959
Name:EMERGENCY PHYSICIANS OF MIDWEST CITY L.L.C.
Entity type:Organization
Organization Name:EMERGENCY PHYSICIANS OF MIDWEST CITY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-348-6621
Mailing Address - Street 1:2412 PANTHEON CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-3236
Mailing Address - Country:US
Mailing Address - Phone:405-691-1159
Mailing Address - Fax:
Practice Address - Street 1:2412 PANTHEON CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-691-1159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty