1306849062 NPI number — MRS. ELIZABETH B PARKHURST P.T.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306849062 NPI number — MRS. ELIZABETH B PARKHURST P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKHURST
Provider First Name:
ELIZABETH
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

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:
1306849062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 862
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALVA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73717-0862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-327-0732
Provider Business Mailing Address Fax Number:
580-327-0737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 BARNES AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
ALVA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73717-2287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-327-0732
Provider Business Practice Location Address Fax Number:
580-327-0737
Provider Enumeration Date:
05/24/2005

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: 225100000X , with the licence number:  546 , 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)

  • Identifier: 73-1103617 . This is a "FEDERAL E.I. NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".