Basic Information
| Provider Information | |||||||||
| NPI: | 1679588552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STILLWATER MEDICAL CENTER AUTHORITY | ||||||||
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| OtherOrganizationName: | COMPREHENSIVE NEUROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1323 W 6TH AVE | ||||||||
| Address2: | BOX 2408 | ||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055332667 | ||||||||
| FaxNumber: | 4057424990 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 6TH AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055332667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HENDREN | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4057425729 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 4112 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.