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Organization
LIFEBRIDGE MEDICAL LLC
Active
Organization
LIFEBRIDGE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE MAC GERMANY PA-C (PHYSICIAN ASSISTANT CEO)
(405) 504-5433
Entity
Organization
Contact information
Practice address
1211 N SHARTEL AVE STE 801, OKLAHOMA CITY, OK 73103-2425
(405) 504-5433
Mailing address
14433 LOCUST ST, PIEDMONT, OK 73078-8910
(405) 488-7543
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
208VP0000X
Pain Medicine Physician
Primary
—
NULL
208VP0000X
Pain Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
261QP3300X
Pain Clinic/Center
—
NULL
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
07/28/2021
Last updated
08/05/2021
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