1477763811 NPI number — GEORGE R PILKINTON LCSW, LADC

Table of content: GEORGE R PILKINTON LCSW, LADC (NPI 1477763811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477763811 NPI number — GEORGE R PILKINTON LCSW, LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PILKINTON
Provider First Name:
GEORGE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LADC
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:
1477763811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 451585
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74345-1585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-786-2930
Provider Business Mailing Address Fax Number:
918-786-5985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32300 S 625 RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74345-1585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-786-2930
Provider Business Practice Location Address Fax Number:
918-786-5985
Provider Enumeration Date:
05/23/2007

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: 101YA0400X , with the licence number:  143 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 3195 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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