| NPI | 1124598149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER M BOOMER Sole Owner Authorized Official 918-638-4223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease |
| 261QE0002X Clinic/Center, Emergency Care | |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2018-12-05 |