| NPI | 1972740264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON GULBRANSON Authorized Official 918-500-4452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OK 3737) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2024-03-28 |