GRAND LAKE REGIONAL CARDIOLOGY SERVICES LLC (NPI# 1811996861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811996861 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE REGIONAL CARDIOLOGY SERVICES LLC |
| Practice Address |
1001 E 18th St Grove OK 74344-2907 |
| Mailing Address |
Po Box 452438 Grove OK 74345-2438 |
| Practice Telephone | 9187861070 |
| Practice Fax Number | 9187867699 |
| Mailing Telephone | 9187861070 |
| Mailing Fax Number | 9187867699 |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2011-12-08 |
| Authorized Official Name | MR. PAUL EDWARD CALLICOAT JR. (PHYSICIAN MANAGER) |
| Authorized Official Telephone | 9187867667 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
========= | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200046050A | 05 |
| Street Address |
1001 E 18TH ST |
| City | GROVE |
| State | OK |
| Zip Code | 74344-2907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023590676 | Jennifer Danielle Prentice | Nurse Practitioner | 1001 E 18th St, Grove, OK 74344-2907 | 2018-08-30 |
| 1598241366 | Stephanie Faith Howell | Nurse Practitioner | 1001 E 18th St, Grove, OK 74344-2907 | 2018-07-16 |
| 1275084303 | Kaci Kretchmar | Nurse Practitioner | 1001 E 18th St, Grove, OK 74344-2907 | 2016-10-24 |
| 1699130344 | Integris Grove Hospital | Medicare Defined Swing Bed Unit | 1001 E 18th St, Grove, OK 74344-2907 | 2015-12-23 |
| 1316338593 | Mandy Jo Hunter | Nurse Practitioner | 1001 E 18th St, Grove, OK 74344-2907 | 2015-02-10 |
| 1245576438 | Sara Margaret Vaughan | Physician Assistant | 1001 E 18th St, Grove, OK 74344-2907 | 2012-12-17 |
| 1124388855 | Midwest Hospital Medicine Associates PC | Physician Assistant | 1001 E 18th St, Grove, OK 74344-2907 | 2012-05-29 |
| 1023378924 | Luke R Leming | Family Medicine | 1001 E 18th St, Grove, OK 74344-2907 | 2012-05-24 |
| 1629377825 | Trevor Kyle Kitchens | Family Medicine | 1001 E 18th St, Grove, OK 74344-2907 | 2011-03-28 |
| 1821395666 | Marcia D. Tynon | Dietitian, Registered | 1001 E 18th St, Grove, OK 74344-2907 | 2011-02-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326604935 | Deborah Stauss | Massage Therapist | 2086 S Main St, Grove, OK 74344 | 2019-05-20 |
| 1841776705 | Progressive Orthotic & Prosthetic Services, Inc | Prosthetic/Orthotic Supplier | 10 E 6th St., Grove, OK 74344 | 2018-07-13 |
| 1205329232 | Andra Renee Mitchell | Speech-Language Pathologist | 825 E Third Street, Grove, OK 74344 | 2018-06-13 |
| 1861996217 | Jenniffer Colleen Clark I | Case Manager/Care Coordinator | 1115 Har-ber Rd, Grove, OK 74344 | 2018-03-21 |
| 1417458167 | Jason S Beckham | Case Manager/Care Coordinator | 32600 S. 625 Road, Grove, OK 74344 | 2018-02-27 |
| 1659872034 | Keli Elaine Whitlock | Peer Specialist | 5602 Us Hwy 59, Grove, OK 74344 | 2018-02-22 |
| 1851899454 | Nichole Marie Wooton | Case Manager/Care Coordinator | 1115 Har-ber Road, Grove, OK 74344 | 2018-01-29 |
| 1043766645 | Samantha Lane | Speech-Language Pathologist | 1046 Hillside Road, Grove, OK 74344 | 2016-09-01 |
| 1376927509 | Matthew Kyle Allen | Physical Therapy Assistant | 4621 Hwy 59 N, Grove, OK 74344 | 2015-07-17 |
| 1477807428 | Andrew Scott Littlejohn | Physical Therapy Assistant | 103 Harber Road, Grove, OK 74344 | 2012-10-30 |
| Find all providers in zip 74344 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124030002 | James B Chapman | Internal Medicine | 900 E 13th St, Suite 200, Grove, OK 74344-2975 | 2006-08-12 |
| 1225037229 | Regional Cardiology Pa | Internal Medicine | 900 E 13th St, Suite 200, Grove, OK 74344-2975 | 2005-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710479324 | Parkway H&v | Internal Medicine | 3200 Quail Springs Pkwy Ste 100, Oklahoma City, OK 73134-2698 | 2018-05-31 |
| 1003315946 | Cardiac Cin of Oklahoma City LLC | Internal Medicine | 10601 S Western Ave # 3, Oklahoma City, OK 73170-6201 | 2018-02-06 |
| 1891097358 | Khurram Liaqat | Internal Medicine | 9020 E Reno Ave Ste 200, Midwest City, OK 73130-3336 | 2010-12-03 |
| 1629118740 | Raghav Gupta | Internal Medicine | 5401 N Portland Ave Ste 380, Oklahoma City, OK 73112 | 2007-02-07 |
| 1699886077 | Bryan Allen Lucenta | Internal Medicine | 101 Rockefeller Dr Ste 100, Muskogee, OK 74401-5050 | 2006-08-31 |
| 1760486484 | Francis H Oliver | Internal Medicine | 731 12th Ave Nw, Ardmore, OK 73401-5761 | 2005-06-09 |
| 1801358981 | Cok Care of Ok, LLC | Internal Medicine | 10601 S Western Ave Ste 3, Oklahoma City, OK 73170-6201 | 2019-04-05 |
| 1447754007 | Rajaram Md Pllc | Internal Medicine | 105 S Bryant Ave, Edmond, OK 73034 | 2018-03-20 |
| 1346784683 | Osu Cardiology | Internal Medicine | 802 S Jackson Ave, Suite 225, Tulsa, OK 74127-9015 | 2016-12-06 |
| 1174956890 | Sahil Agrawal | Internal Medicine | 6151 S Yale Ave Ste 100a, Tulsa, OK 74136-1929 | 2013-08-16 |
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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.