OrganizationActive
Grand Lake Regional Cardiology Services LLC
NPI 1811996861 · Interventional Cardiology Physician · Grove, OK
Provider details
- NPI number
- 1811996861
- Entity type
- Organization
- Primary specialty
- Interventional Cardiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Paul Callicoat, Physician Manager(918) 786-7667
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1001 E 18th St
Grove, OK 74344-2907
Phone: (918) 786-1070
Fax: (918) 786-7699
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 452438
Grove, OK 74345-2438
Registry dates
- Enumerated
- 2005-07-20
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.