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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
208VP0000X
Pain Medicine Physician
Primary
261QM1300X
Multi-Specialty Clinic/Center
261QP3300X
Pain Clinic/Center
363AM0700X
Medical Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1770740680
OK
Enumeration date
07/28/2021
Last updated
08/05/2021
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