Basic Information
| Provider Information | |||||||||
| NPI: | 1689738395 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHS OKLAHOMA PHYSICIAN GROUP, LLC | ||||||||
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| OtherOrganizationName: | KRISTIN SELLS, PA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 S UTICA AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185793825 | ||||||||
| FaxNumber: | 9185791262 | ||||||||
| Practice Location | |||||||||
| Address1: | 1206 MANVEL AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CHANDLER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748344401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052585252 | ||||||||
| FaxNumber: | 4052585552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LANGLAND | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9185791000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.