Provider Demographics
NPI:1316105844
Name:TAF ANCILLARY MEDICAL SERVICES CO
Entity type:Organization
Organization Name:TAF ANCILLARY MEDICAL SERVICES CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-214-6699
Mailing Address - Street 1:RR 1 BOX 469
Mailing Address - Street 2:
Mailing Address - City:TERLTON
Mailing Address - State:OK
Mailing Address - Zip Code:74081-9738
Mailing Address - Country:US
Mailing Address - Phone:918-865-7177
Mailing Address - Fax:918-865-7177
Practice Address - Street 1:300 W OSAGE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4609
Practice Address - Country:US
Practice Address - Phone:918-865-7177
Practice Address - Fax:918-865-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service