1629130166 NPI number — NORMAN ALCOHOL INFORMATION CENTER

Table of content: (NPI 1629130166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629130166 NPI number — NORMAN ALCOHOL INFORMATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN ALCOHOL INFORMATION CENTER
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:
THE VIRTUE CENTER
Provider Other Organization Name Type Code:
3
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:
1629130166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-0730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-321-0022
Provider Business Mailing Address Fax Number:
405-360-4918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2457 WILCOX DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73069-3956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-321-0022
Provider Business Practice Location Address Fax Number:
405-321-0022
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLADO
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/CEO
Authorized Official Telephone Number:
405-321-0022

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100709520A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629130166 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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