Owasso Medical Facility LLC

Primary specialty

Institutional PharmacyTaxonomy code 3336I0012X

License

25121 Issued in OK

Legal business name

OWASSO MEDICAL FACILITY LLC

Doing business as

St John Owasso

Practice address

12451 E 100TH St N
Owasso, OK 74055-4600

Phone

(918) 274-5046

Fax

(918) 274-5148

NPI assigned

Nov 29, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Phillips

Title

Ceo

Phone

(918) 274-5100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ST JOHN OWASSO Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437226917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12451 E 100TH ST N",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740554600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12451 E 100TH ST N",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740554600",
            "telephone_number": "918-274-5046",
            "fax_number": "918-274-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWASSO MEDICAL FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-274-5100"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "OK",
            "license": "25121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3724728",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST JOHN OWASSO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Owasso Dialysis LLC (Owasso Dialysis)
• Owasso Drug Company LLC (Owasso Drug)
• Owasso Eye Institute Inc
• Owasso Family Denistry
• Owasso Family Medicine, PLLC
• Owasso Medical Facility LLC
• Owasso Medical Facility, Inc (St. John Owasso)
• Owasso Nursing Center, Inc. (Sequoyah Pointe Living Center)
• Owasso Orthodontics
• Owasso Pain Management

• Institutional Pharmacy in Owasso, OK
• Providers in Owasso, OK by specialty
• Institutional Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.