| Organization Name: | MISSION PHYSICIAN SERVICES, LLC |
| NPI Number: | 1528291507 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM R ANDERSON (OFFICER) |
| Mailing Address: | 3220 S Peoria Ave Suite 101 Tulsa |
| State: | OK US |
| Postal Code: | 741052003 |
| Phone Number: | 8772284951 |
| Fax Number: | 9184895620 |
| NPI Enumeration Date: | 08/25/2009 |
| NPI Last Update Date: | 08/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |