# SOUTHCREST MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992736250
- **Authorized official:** DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
- **Authorized official phone:** (877) 892-9813

## Contact information

- **Practice address:** 6528 E 101ST ST, STE I, TULSA, OK 74133-6724
- **Practice address phone:** (918) 294-4803
- **Mailing address:** 7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 04/20/2008