Organization
KAY COUNTY CLINIC COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN A PEOPLES (VP, PHYSICIAN OPERATIONS)
(615) 465-7585
Entity
Organization
Contact information
Practice address
1900 N 14TH ST, PONCA CITY, OK 74601-2035
(580) 765-3321
(580) 765-0341
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7000
(615) 465-3007
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200092160A
—
OK
Enumeration date
06/15/2006
Last updated
08/02/2021
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