Basic Information
Provider Information
NPI: 1184858375
EntityType: 2
ReplacementNPI:  
OrganizationName: MUSKOGEE MEDICAL AND SURGICAL ASSOCIATES, LLC
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Mailing Information
Address1: 501 CORPORATE CENTRE DR
Address2: SUITE 200
City: FRANKLIN
State: TN
PostalCode: 370672659
CountryCode: US
TelephoneNumber: 6157643000
FaxNumber:  
Practice Location
Address1: 3520 CHANDLER RD
Address2:  
City: MUSKOGEE
State: OK
PostalCode: 744034910
CountryCode: US
TelephoneNumber: 9186820721
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/04/2009
LastUpdateDate: 10/29/2009
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AuthorizedOfficialLastName: SLIPKOVICH
AuthorizedOfficialFirstName: DANIEL
AuthorizedOfficialMiddleName: S.
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 6157643000
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialNamePrefix: MR.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 
207V00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 
208G00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 
208600000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 
207X00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207Q00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
OKB563401OKMEDICARE GRPOTHER


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