Organization
MEMORIAL MEDICAL GROUP EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY ENLOE (CFO)
(405) 752-3161
Entity
Organization
Contact information
Practice address
1011 14TH AVE NW, ARDMORE, OK 73401-1828
(580) 223-5400
Mailing address
PO BOX 504539, SAINT LOUIS, MO 63150-0001
(405) 759-7725
(405) 759-7730
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015840A
—
OK
Enumeration date
07/16/2007
Last updated
10/16/2018
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