# OWASSO MEDICAL FACILITY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST JOHN OWASSO
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437226917
- **Authorized official:** DAVID PHILLIPS (CEO)
- **Authorized official phone:** (918) 274-5100

## Contact information

- **Practice address:** 12451 E 100TH ST N, OWASSO, OK 74055-4600
- **Practice address phone:** (918) 274-5046
- **Practice address fax:** (918) 274-5148
- **Mailing address:** 12451 E 100TH ST N, OWASSO, OK 74055-4600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | 25121 | OK | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3724728 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |