1952611378 NPI number — MISSION PHYSICIAN SERVICES OF OKLAHOMA, LLC

Table of content: (NPI 1952611378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952611378 NPI number — MISSION PHYSICIAN SERVICES OF OKLAHOMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION PHYSICIAN SERVICES OF OKLAHOMA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952611378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 S PEORIA AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74105-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-770-4441
Provider Business Mailing Address Fax Number:
918-712-9880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3220 S PEORIA AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74105-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-770-4441
Provider Business Practice Location Address Fax Number:
918-712-9880
Provider Enumeration Date:
10/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
918-770-4441

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com