Provider Demographics
NPI:1104638667
Name:AV MEDICAL PLLC
Entity type:Organization
Organization Name:AV MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:AVIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-261-0900
Mailing Address - Street 1:10741 S 70TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7114
Mailing Address - Country:US
Mailing Address - Phone:918-200-9187
Mailing Address - Fax:539-390-3009
Practice Address - Street 1:201 S ADAIR ST STE A
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-5225
Practice Address - Country:US
Practice Address - Phone:918-200-9187
Practice Address - Fax:539-390-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty