Provider Demographics
NPI:1902140056
Name:ASMG SAND SPRINGS
Entity Type:Organization
Organization Name:ASMG SAND SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-260-2075
Mailing Address - Street 1:3905 S HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3839
Mailing Address - Country:US
Mailing Address - Phone:918-260-2093
Mailing Address - Fax:918-508-7442
Practice Address - Street 1:3905 S HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-3839
Practice Address - Country:US
Practice Address - Phone:918-260-2093
Practice Address - Fax:918-508-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care