Grand Lake Regional Cardiology Services LLC

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

GRAND LAKE REGIONAL CARDIOLOGY SERVICES LLC

Practice address

1001 E 18TH St
Grove, OK 74344-2907

Phone

(918) 786-1070

Fax

(918) 786-7699

NPI assigned

Jul 20, 2005

Last updated

Jul 21, 2022By 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

Mr. Paul Edward Callicoat Jr., MDNPI 1063411536

Title

Physician Manager

Phone

(918) 786-7667

Specialties & licenses 1

Addresses

Other identifiers 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Integris Grove Hospital

  dba INTEGRIS Express Care Grove

  • Rural Health Clinic/Center
  • Grove, OK
  • NPI 1689274391

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul Edward Callicoat Jr., MD

  • Cardiovascular Disease Physician
  • Grove, OK
  • NPI 1063411536
  NPD (past) Authorized official

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1811996861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 452438",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743452438",
            "telephone_number": "918-786-1070",
            "fax_number": "918-786-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E 18TH ST",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442907",
            "telephone_number": "918-786-1070",
            "fax_number": "918-786-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE REGIONAL CARDIOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CALLICOAT",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PHYSICIAN MANAGER",
        "authorized_official_telephone_number": "918-786-7667",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200046050A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Grand Lake Mental Health Center, Inc.
• Grand Lake Mental Health Center, Inc.
• Grand Lake Mental Health Center, Inc. (Grand Lake Medical Health Center)
• Grand Lake Optical, LLC
• Grand Lake Therapeutics LLC
• Grand Lake Villa LLC
• Grandwood Assisted Living, LC
• Christopher Gray, NP
• Sarah Green, MSW

• Interventional Cardiology Physician in Grove, OK
• Providers in Grove, OK by specialty
• Interventional Cardiology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.