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Organization
OWASSO MEDICAL FACILITY LLC
Active
Organization
OWASSO MEDICAL FACILITY LLC
Active
Other names
ST JOHN OWASSO
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PHILLIPS (CEO)
(918) 274-5100
Entity
Organization
Contact information
Practice address
12451 E 100TH ST N, OWASSO, OK 74055-4600
(918) 274-5046
(918) 274-5148
Mailing address
12451 E 100TH ST N, OWASSO, OK 74055-4600
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
25121
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3724728
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/29/2006
Last updated
08/22/2020
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