1487826608 NPI number — DRS KARLAK AND MARTIN

Table of content: (NPI 1487826608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487826608 NPI number — DRS KARLAK AND MARTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS KARLAK AND MARTIN
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:
1487826608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 E 19TH ST
Provider Second Line Business Mailing Address:
SUITE 602
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74104-5437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-748-7677
Provider Business Mailing Address Fax Number:
918-748-7606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 E 19TH ST
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-5437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-748-7677
Provider Business Practice Location Address Fax Number:
918-748-7606
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
LYNDA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
918-748-7677

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  14327 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 14394 , 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)

  • Identifier: 04444887152 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 444488715P . This is a "MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 484622519001 . This is a "BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 730536372059 . This is a "BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 00484622519 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 048462251T . This is a "MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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