Organization
CMS OUTPATIENT CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R, STAFFORD DO (PHYSICIAN)
(580) 310-0015
Entity
Organization
Contact information
Practice address
201 N MONTE VISTA ST, SUITE C, ADA, OK 74820-7220
(580) 310-0015
(580) 310-0909
Mailing address
201 N MONTE VISTA ST, SUITE C, ADA, OK 74820-7220
(580) 310-0015
(580) 310-0909
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200039450A
—
OK
05
—
200039450B
—
OK
Enumeration date
12/05/2006
Last updated
08/17/2009
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