Canyon Park Medical Group, Pllc

LBN: Canyon Park Medical Group, Pllc
Canyon Park Medical Group, Pllc is an health care organization with primary practice located at 1501 E 19Th St , Edmond OK 73013-6618. The organization recently has only one registered license in Ambulatory Health Care Facilities / Primary Care, which is considered as the primary health care specialty. Canyon Park Medical Group, Pllc can be contacted via phone (405) 348-6611, or through Keith, Tonya Lynn via phone (405) 348-6611.

Contact Information

Primary practice address
1501 E 19Th St Edmond OK 73013-6618
Phone: (405) 348-6611
Fax: (405) 348-9280
Website:
Map and Directions
Authorized official contact:
Name: Keith, Tonya Lynn
Phone: (405) 348-6611

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Primary Care 261QP2300X 8699 Oklahoma

Profile Details

NPI number 1063525954
LBN Legal business name Canyon Park Medical Group, Pllc
DBA Doing business as
Authorized official Keith, Tonya Lynn
Entity Organization
Organization subpart 1 No
Enumeration date Aug 16th, 2006
Last updated May 2nd, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063525954 NPPES
Oklahoma Other 37DO469469 CLIA #
Oklahoma Other CH5055 CLIA #
Oklahoma MEDICAID 100748060A CLIA #
Oklahoma Other 4589400001 CLIA #

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