Organization · NPI-2

Ahs Oklahoma Physician Group LLC

Family Medicine · Tulsa, OK

NPI number1235182775

StatusActive

Last updated in NPPESApr 6, 2026

Details

NPI: 1235182775
Entity type: Organization (NPI-2)
Legal business name: Ahs Oklahoma Physician Group LLC
Organization subpart: No
Enumeration date: May 17, 2006
Certification date: Apr 6, 2026
Last updated: Apr 6, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	–	–	Yes
208600000X	Surgery	–	–
208800000X	Urology	–	–
363L00000X	Nurse Practitioner	–	–
207T00000X	Neurological Surgery	–	–
207R00000X	Internal Medicine	–	–
363A00000X	Physician Assistant	–	–
207X00000X	Orthopaedic Surgery	–	–
207Y00000X	Otolaryngology	–	–
2080P0210X	Pediatrics, Pediatric Nephrology	–	–
208000000X	Pediatrics	–	–
2080P0006X	Pediatrics, Developmental - Behavioral Pediatrics	–	–
2081P2900X	Physical Medicine & Rehabilitation, Pain Medicine	–	–
207RI0200X	Internal Medicine, Infectious Disease	–	–
2084N0400X	Psychiatry & Neurology, Neurology	–	–

Other names

Utica Park Clinic (Doing Business As)

Practice location

1120 S Utica Ave Ste 100
Tulsa, OK 74104-4012

Phone 918-579-3826 · Fax 918-579-1262

Mailing address

340 Seven Springs Way Ste 100
Brentwood, TN 37027-5697

Phone 615-296-3594

Authorized official

Stephen C. Petrovich
Evp General Counsel
6152963594

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