Organization
SOUTHCREST MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
6528 E 101ST ST, STE I, TULSA, OK 74133-6724
(918) 294-4803
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/05/2006
Last updated
04/20/2008
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