Organization
LONE STAR UROLOGY CONSULTANTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY ORTLIP (OFFICE MANAGER)
(580) 924-8884
Entity
Organization
Contact information
Practice address
1323 N 16TH AVE, DURANT, OK 74701-2134
(580) 924-8884
(580) 924-8911
Mailing address
PO BOX 456, DURANT, OK 74702-0456
(580) 924-8884
(580) 924-8911
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
20400
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ8453
RAILROAD MEDICARE
OK
Enumeration date
10/24/2006
Last updated
01/23/2008
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