Prairie Gardens Medical LLC
General Practice in Oklahoma City, OK. Organization (NPI-2).
NPI number1669080891
StatusActive
Last updated in NPPESSep 16, 2020
Details
- NPI
- 1669080891
- Entity type
- Organization (NPI-2)
- Legal business name
- Prairie Gardens Medical LLC
- Organization subpart
- No
- Enumeration date
- Jul 14, 2020
- Certification date
- Sep 16, 2020
- Last updated
- Sep 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Practice location
1213 Nw 122nd St Ste 401Oklahoma City, OK 73114-7000
Phone 405-962-8123 · Fax 405-962-8125
Mailing address
175 Lary LnGuthrie, OK 73044-6542
Phone 405-962-8123 · Fax 405-962-8125
Authorized official
Dianne G Tupper
Managing Partner
4057428898
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