OSUMC PROFESSIONAL SERVICES LLC (NPI# 1730793696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730793696 |
| Entity Type | Organization |
| Organization Name | OSUMC PROFESSIONAL SERVICES LLC |
| Practice Address |
112 W 5th Street Okmulgee OK 74447-0000 |
| Mailing Address |
2401 Southwest Blvd Tulsa OK 74107-2726 |
| Practice Telephone | 9187521080 |
| Practice Fax Number | 9187521081 |
| Mailing Telephone | 9185615701 |
| Mailing Fax Number | 9185611173 |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2020-09-08 |
| Authorized Official Name | SAMANTHA KAY OVERFIELD (CREDENTIALING ADMINISTRATOR) |
| Authorized Official Telephone | 9185615714 |
| Is Organization Subpart | Y |
| Parent Organization Name | OSUMC PROFESSIONAL SERVICES LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| OSU Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154845501 | Osumc Professional Services LLC | Family Medicine | 514 Plaza Ct, Sand Springs, OK 74063-7915 | 2017-07-27 |
| 1922325992 | Osumc Professional Services LLC | Internal Medicine | 744 W 9th St, Tulsa, OK 74127-9020 | 2010-04-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | OSUMC PROFESSIONAL SERVICES LLC | 744 W. 9th Street, Tulsa, OK 74127-9020 |
| Street Address |
112 W 5TH STREET |
| City | OKMULGEE |
| State | OK |
| Zip Code | 74447-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932718376 | David Louis Holden | Counselor | 1803 W Wood Drive, Okmulgee, OK 74447 | 2020-07-30 |
| 1972097657 | Impact Rehab Consultants | Occupational Therapist | 114 West 7th Street, Okmulgee, OK 74447 | 2018-06-18 |
| 1992192504 | Taquia Bagby | Counselor | 1117 Martin L King Dr., Okmulgee, OK 74447 | 2015-04-21 |
| 1174935886 | Heather Houser | Case Manager/Care Coordinator | 1803 South Wood Drive, Okmuglee, OK 74447 | 2014-05-29 |
| 1376977066 | Anita Kaye Stallings | Case Manager/Care Coordinator | 1018 E 2nd St, Okmulgee, OK 74447 | 2013-08-29 |
| 1013283209 | Megan Breffney Wilson | Family Medicine | 112 West 5th Street, Okmulgee, OK 74447 | 2012-04-01 |
| 1245475466 | Mary Jones | Counselor | 323 W 6th Street, Okmulgee, OK 74447 | 2008-12-03 |
| 1881872182 | State of Oklahoma | Skilled Nursing Facility | 900 E. Airport Rd., Okmulgee, OK 74447 | 2008-02-08 |
| 1053539965 | Shannon Michelle Allison | Physical Therapist | 900 E. Airport Road, Okmulgee, OK 74447 | 2007-04-23 |
| 1023233772 | Ky Joel Kiger | Physical Therapist | 900 East Airport Road, Okmulgee, OK 74447 | 2007-04-16 |
| Find all providers in zip 74447 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013283209 | Megan Breffney Wilson | Family Medicine | 112 West 5th Street, Okmulgee, OK 74447 | 2012-04-01 |
| 1356674519 | Kim Samuel Young | Family Medicine | 1101 S Belmont Ave Ste 102, Okmulgee, OK 74447-6315 | 2009-09-04 |
| 1093829269 | Tsq Inc | Family Medicine | 1151 South Belmont, Suite 101, Okmulgee, OK 74447 | 2006-08-18 |
| 1598774242 | Margaret Ann Stripling | Family Medicine | 1101 S Belmont Ave Ste 106, Okmulgee, OK 74447-6315 | 2006-08-05 |
| 1174024426 | Access Solutions Medical Group II | Family Medicine | 100 W 7th St, Okmulgee, OK 74447-5050 | 2018-02-22 |
| 1487017398 | Medrite Health LLC | Family Medicine | 109 W 6th St, Okmulgee, OK 74447 | 2016-03-30 |
| 1144392804 | George M Jennings | Family Medicine | 211 N Grand Ave, Okmulgee, OK 74447-4036 | 2006-11-15 |
| 1346356862 | Tracy Smith Sanford | Family Medicine | 1151 S Belmont Ave, Suite 101, Okmulgee, OK 74447-6307 | 2006-08-21 |
| 1992819197 | Timothy Herbert Sanford | Family Medicine | 1151 S Belmont Ave, Suite 101, Okmulgee, OK 74447-6307 | 2006-08-18 |
| 1831112572 | Zachariah J Anderson | Family Medicine | 1101 S Belmont Ave Ste 102, Okmulgee, OK 74447-6315 | 2006-07-25 |
| Find all providers in OKMULGEE | ||||
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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.