Organization Name: | COWETA MEDICAL GROUP,P.L.L.C. |
NPI Number: | 1316183536 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEFF BARENTINE (OWNER) |
Mailing Address: | 28622 E 141st St So. Coweta |
State: | OK US |
Postal Code: | 74429 |
Phone Number: | 9184867425 |
Fax Number: | |
NPI Enumeration Date: | 12/17/2008 |
NPI Last Update Date: | 01/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |