Basic Information
| Provider Information | |||||||||
| NPI: | 1871769067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OBSTETRICAL ANESTHESIA OF ENID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 DEER RUN | ||||||||
| Address2: | |||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737033426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802423003 | ||||||||
| FaxNumber: | 5802376174 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S MONROE ST | ||||||||
| Address2: | |||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737017211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802332300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5802423003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 1982 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.