1730369547 NPI number — ADAIR COUNTY HEALTH CENTER,INC.

Table of content: (NPI 1730369547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730369547 NPI number — ADAIR COUNTY HEALTH CENTER,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAIR COUNTY HEALTH CENTER,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:
PHYSICIANS CLINIC DBA NICHOLAS BENTLEY, D.O.
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:
1730369547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 W LOCUST ST
Provider Second Line Business Mailing Address:
102
Provider Business Mailing Address City Name:
STILWELL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74960-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-696-4065
Provider Business Mailing Address Fax Number:
918-696-5971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W LOCUST ST
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
STILWELL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74960-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-696-4065
Provider Business Practice Location Address Fax Number:
918-696-5971
Provider Enumeration Date:
11/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
918-696-4065

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2348 , 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: 100200460A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".