1679667836 NPI number — MERCY HOSPITAL OKLAHOMA CITY, INC.

Table of content: (NPI 1679667836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679667836 NPI number — MERCY HOSPITAL OKLAHOMA CITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL OKLAHOMA CITY, INC.
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:
1679667836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 W MEMORIAL RD
Provider Second Line Business Mailing Address:
ATTN: JON VITIELLO
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-8304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-725-3724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 W MEMORIAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-8304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-755-1515
Provider Business Practice Location Address Fax Number:
405-752-3811
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VITIELLO
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
405-752-3724

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000370013-001 . This is a "BC/BS # - ACUTE & REHAB" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".