Organization
REGIONAL CARDIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL E CALLICOAT JR. MD (PHYSICIAN)
(918) 786-7667
Entity
Organization
Contact information
Practice address
900 E 13TH ST, SUITE 200, GROVE, OK 74344-2975
(918) 786-7667
(918) 786-7699
Mailing address
PO BOX 450968, GROVE, OK 74345-0968
(918) 786-7667
(918) 786-7699
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100723550A
—
OK
01
—
CB3609
RAILROAD MEDICARE
MO
01
—
I8-1224365-74344
TRI CARE FOR LIFE
OK
01
—
I8-1224365-74344A001
CHAMPUS
OK
Enumeration date
07/20/2005
Last updated
07/21/2022
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