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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