Basic Information
| Provider Information | |||||||||
| NPI: | 1316196496 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUYMON EMERGENCY MEDICINE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 S 36TH ST | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744015044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187819466 | ||||||||
| FaxNumber: | 9187811375 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 MEDICAL DR | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | GUYMON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 739424438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803383113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2008 | ||||||||
| LastUpdateDate: | 09/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | WINN | ||||||||
| AuthorizedOfficialFirstName: | BERRY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9187819466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.