BLUE STAR MEDICAL GROUP PLLC (NPI# 1619126489) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619126489 |
| Entity Type | Organization |
| Organization Name | BLUE STAR MEDICAL GROUP PLLC |
| Practice Address |
3115 Sw 89th St Oklahoma City OK 73159-7901 |
| Practice Telephone | 4054245630 |
| Mailing Telephone | 4054245630 |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |
| Authorized Official Name | GLENDA COHRS (ADMINISTRATOR) |
| Authorized Official Telephone | 4054245630 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Street Address |
3115 SW 89TH ST |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73159-7901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154313047 | Daron C. Hitt | Surgery | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2005-08-17 |
| 1104245588 | Virginia Tammy Thomas | Nurse Practitioner | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2014-04-14 |
| 1447516430 | Gerardo Myrin | Orthopaedic Surgery | 3115 Sw 89th St, Oklahoma City, OK 73159 | 2012-04-04 |
| 1972872448 | Oklahoma Medical Pain Management | Pain Medicine | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2011-12-29 |
| 1689968729 | Charles Andrew Hogan | Orthopaedic Surgery | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2011-06-07 |
| 1891025144 | Thomas Dale Reeder II | Neurological Surgery | 3115 Sw 89th St, Osso Spine Center, Oklahoma City, OK 73159-7901 | 2010-01-09 |
| 1396995197 | New Haven, LLC | Specialist | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2008-09-29 |
| 1578665063 | Christopher Shane Hume | Orthopaedic Surgery | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2006-09-04 |
| 1730155813 | Vincent J. Devlin | Orthopaedic Surgery | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2006-02-27 |
| 1710958269 | Mark C Denney | Physician Assistant | 3115 Sw 89th St, Oklahoma City, OK 73159-7901 | 2006-01-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346849528 | Mel Vision LLC | Optometrist | 1413 W Interstate 240 Service Rd, Suite E, Oklahoma City, OK 73159 | 2020-10-20 |
| 1053959247 | Phillip J Elassal Dds Pllc | Clinic/Center | 1601 Sw 89th Street #g500, Oklahoma City, OK 73159 | 2019-12-18 |
| 1629573407 | Carrie Lynn Sanchez | Case Manager/Care Coordinator | 2604 Sw 92nd Street, Oklahoma City, OK 73159 | 2018-03-26 |
| 1407368038 | Deborah Dorton | Psychologist | Okc Va Hcs (111a), 921 Ne 13th St, Oklahoma City, OK 73159 | 2017-11-06 |
| 1366969933 | Matthew Lewis Hearne | Case Manager/Care Coordinator | 7504 S Country Club Dr, Apt 105, Oklahoma City, OK 73159 | 2017-08-24 |
| 1043766405 | Pro Hearing, LLC | Clinic/Center | 10404 S Pennsylvania Ave, Oklahoma City, OK 73159 | 2016-08-26 |
| 1952764169 | Doc LLC | Orthopaedic Surgery | 3130 Sw 89th St Ste 200e, Oklahoma City, OK 73159 | 2016-04-04 |
| 1235511288 | Anusha Koneru | Dentist | 1610 W Interstate 240 Service Road, Oklahoma City, OK 73159 | 2015-06-26 |
| 1114347069 | Crystal A Dockery | Family Medicine | 3212 Sw 89th St Ste 100, Oklahoma City, OK 73159 | 2014-04-18 |
| 1790121440 | Kimberly Anne Dyer | Occupational Therapy Assistant | 5725 S Ross, Oklahoma City, OK 73159 | 2013-05-21 |
| Find all providers in zip 73159 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932634789 | Suboxone Solutions LLC | Specialist | 10813 N Macarthur Blvd Ste W, Oklahoma City, OK 73162-6904 | 2017-04-28 |
| 1245656461 | Chris Kunkel | Specialist | 2900 Purdue Dr, Oklahoma City, OK 73128-5808 | 2014-03-12 |
| 1235554338 | Megan Peters | Specialist | 8521 N Eastern Ave, Oklahoma City, OK 73131-4031 | 2014-02-26 |
| 1821332438 | Tsa Eshelle King | Specialist | 1330 N Classen Blvd Ste 307, Oklahoma City, OK 73106-6834 | 2012-11-20 |
| 1841542859 | Tempest Johann Johnson | Specialist | 1210 Sw 77th Ter, Oklahoma City, OK 73139-2439 | 2012-10-15 |
| 1861753956 | Rickey Lee Great | Specialist | 834 Ne 36th St, Oklahoma City, OK 73105-7206 | 2012-06-05 |
| 1154689487 | Connie L Burch | Specialist | 3112 Nw Expressway Apt 115, Oklahoma City, OK 73112-4016 | 2012-04-24 |
| 1437433125 | Virginia Parrish | Specialist | 222 E Sheridan Ave, Oklahoma City, OK 73104-4233 | 2011-09-29 |
| 1356650675 | Richard C. Greyson, M.d., A Professional Corporation | Specialist | 1110 N Classen Blvd Ste 301, Oklahoma City, OK 73106-6842 | 2010-10-04 |
| 1992017420 | Maurice Upshaw Jr. | Specialist | 3035 Nw 63rd St Ste 201n, Oklahoma City, OK 73116-3606 | 2010-07-13 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73159 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.