Davenport Medical Center LLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

242 Issued in OK

Legal business name

DAVENPORT MEDICAL CENTER LLC

Practice address

203 N Broadway
Davenport, OK 74026

Phone

(405) 249-9611

NPI assigned

Mar 29, 2011

Last updated

Mar 29, 2011By 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

Tracy Wohlgemuth

Title

Manager

Phone

(405) 249-9611

Specialties & licenses 1

Addresses

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.

• Mebin Babu Thomas, PA-C

  • Medical Physician Assistant
  • Oklahoma City, OK
  • NPI 1598082737
  NPD (past)

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

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1992094049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N BROADWAY",
            "city": "DAVENPORT",
            "state": "OK",
            "postal_code": "74026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 N BROADWAY",
            "city": "DAVENPORT",
            "state": "OK",
            "postal_code": "74026",
            "telephone_number": "405-249-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-29",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "WOHLGEMUTH",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "405-249-9611"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Davenport Public Schools
• Christina M. Jefferson, MD
• Seelig Medical Clinic
• Town of Davenport

• Medical Physician Assistant in Davenport, OK
• Providers in Davenport, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; 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.