Organization
EDMOND PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE JONES (DIRECTOR OF PATIENT ACCOUNTING)
(405) 271-8132
Entity
Organization
Contact information
Practice address
105 S BRYANT AVE STE 105, EDMOND, OK 73034-6330
(405) 715-3102
Mailing address
PO BOX 744503, ATLANTA, GA 30374-4503
(405) 271-8132
(405) 271-5006
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200045590A
—
OK
Enumeration date
06/08/2006
Last updated
03/11/2019
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