Organization
NORTHWEST INSTITUTE OF SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENE LESTER MUSE M.D. (PHYSICIAN)
(405) 787-7678
Entity
Organization
Contact information
Practice address
4200 W MEMORIAL RD, SUITE 1001, OKLAHOMA CITY, OK 73120-9350
(405) 787-7678
(405) 751-3367
Mailing address
4200 W MEMORIAL RD, SUITE 1001, OKLAHOMA CITY, OK 73120-9350
(405) 787-7678
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11348
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200061670A
—
OK
01
—
444600470002
BLUE CROSS BLUE SHIELD
OK
Enumeration date
03/23/2007
Last updated
06/19/2009
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