1316181720 NPI number — DR. PATRICK JAMES ROSS M.D.

Table of content: DR. PATRICK JAMES ROSS M.D. (NPI 1316181720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316181720 NPI number — DR. PATRICK JAMES ROSS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
PATRICK
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1316181720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 S YALE AVE STE 1400
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:
74136-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-247-0125
Provider Business Mailing Address Fax Number:
918-502-8001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 ROCKEFELLER DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKOGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74401-5050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-682-4580
Provider Business Practice Location Address Fax Number:
918-681-4566
Provider Enumeration Date:
04/29/2009

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: 208600000X , with the licence number:  27227 , 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: 27227 . This is a "STATE LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200247530A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 221178 . This is a "LIMITED STATE LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".