Organization
CARDIOLOGY CLINIC OF MUSKOGEE, INC.
Active
Organization
CARDIOLOGY CLINIC OF MUSKOGEE, INC.
Active
Other names
CCOM Medical Group, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
ANN BARKER ONG (CORPORATE SECRETARY)
(918) 683-0753
Entity
Organization
Contact information
Practice address
350 S 40TH ST, CCOM MEDICAL GROUP, MUSKOGEE, OK 74401-4915
(918) 683-0753
Mailing address
350 S 40TH ST, CCOM MEDICAL GROUP, MUSKOGEE, OK 74401-4915
(918) 683-0753
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RR0500X
Rheumatology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734500A
—
OK
Enumeration date
03/17/2006
Last updated
03/25/2021
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