Basic Information
| Provider Information | |||||||||
| NPI: | 1972628352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHS OKLAHOMA PHYSICIAN GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 562 S ELLIOTT ST | ||||||||
| Address2: | |||||||||
| City: | PRYOR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743616411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188253389 | ||||||||
| FaxNumber: | 9188255505 | ||||||||
| Practice Location | |||||||||
| Address1: | 562 S ELLIOTT ST | ||||||||
| Address2: | |||||||||
| City: | PRYOR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743616411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188253389 | ||||||||
| FaxNumber: | 9188255505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BATTLES | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 9188253389 | ||||||||
| 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 | 207QA0000X | 2080 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine |
No ID Information.