Organization
LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Active
Other names
Center for Internal Medicine and Pediatrics - Waterloo
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE ROWLEY (CHIEF EXECUTIVE OFFICER)
(405) 282-6700
Entity
Organization
Contact information
Practice address
301 E WATERLOO RD, EDMOND, OK 73034
(405) 715-2000
Mailing address
PO BOX 1017, GUTHRIE, OK 73044-1017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2267
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD8588
RAILROAD MEDICARE
—
Enumeration date
05/07/2007
Last updated
11/15/2007
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