Provider Demographics
NPI:1457785693
Name:MEDSTAFFPC
Entity Type:Organization
Organization Name:MEDSTAFFPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7428
Mailing Address - Street 1:4500 S 129TH EAST AVE
Mailing Address - Street 2:STE 191
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5801
Mailing Address - Country:US
Mailing Address - Phone:918-779-7400
Mailing Address - Fax:918-779-7425
Practice Address - Street 1:12800 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2576
Practice Address - Country:US
Practice Address - Phone:918-394-0940
Practice Address - Fax:404-494-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty