Provider Demographics
NPI:1578753620
Name:OKLAHOMA PERFUSION, INC
Entity type:Organization
Organization Name:OKLAHOMA PERFUSION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:405-601-0954
Mailing Address - Street 1:3601 N MAY AVE
Mailing Address - Street 2:STE C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6641
Mailing Address - Country:US
Mailing Address - Phone:405-601-0954
Mailing Address - Fax:405-601-3750
Practice Address - Street 1:3601 N MAY AVE
Practice Address - Street 2:STE C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6641
Practice Address - Country:US
Practice Address - Phone:405-601-0954
Practice Address - Fax:405-601-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLP 8174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty