Basic Information
| Provider Information | |||||||||
| NPI: | 1033172168 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GROUP PRACTICE ASSOCIATES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STILLWATER INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6585 S YALE AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741368384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184812767 | ||||||||
| FaxNumber: | 9184817611 | ||||||||
| Practice Location | |||||||||
| Address1: | 709 S WESTERN RD | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057079800 | ||||||||
| FaxNumber: | 4057070004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9184817616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | OK | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207R00000X | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.