1295031359 NPI number — MONICA M. ROSAS LADC-MH

Table of content: MONICA M. ROSAS LADC-MH (NPI 1295031359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295031359 NPI number — MONICA M. ROSAS LADC-MH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSAS
Provider First Name:
MONICA
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LADC-MH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HINKLEY
Provider Other First Name:
MONICA
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LADC-MH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295031359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 SW 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73109-5610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-236-0701
Provider Business Mailing Address Fax Number:
405-236-0737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SSMH - ST. ANTHONY'S HOSPITAL
Provider Second Line Business Practice Location Address:
2825 PARKLAWN DRIVE
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-610-4411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 1406 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 1406 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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