Organization
WOMENS HEALTH & WELLNESS
Active
Parent organization
ST. MARY PHYSICIAN ASSOCIATES, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY PHYSICIAN ASSOCIATES, LLC
Authorized official
MS. JACQUELINE GIBSON-BURRIS CPC (PRACTICE MANAGEMENT MANAGER)
(580) 249-3706
Entity
Organization
Contact information
Practice address
615 E OKLAHOMA AVE, SUITE 203, ENID, OK 73701-5951
(580) 242-3870
(580) 242-4046
Mailing address
615 E OKLAHOMA AVE, SUITE 203, ENID, OK 73701-5951
(580) 242-3870
(580) 242-4046
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
8721
OK
207VG0400X
Gynecology Physician
11867
OK
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
R0048498
OK
Other
Enumeration date
10/06/2005
Last updated
02/21/2011
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