1750607651 NPI number — PINNACLE HEALTHCARE OF OKLAHOMA LLP

Table of content: (NPI 1750607651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750607651 NPI number — PINNACLE HEALTHCARE OF OKLAHOMA LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTHCARE OF OKLAHOMA LLP
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:
PINNACLE ORTHOPEDICS
Provider Other Organization Name Type Code:
5
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:
1750607651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4140 SE ADAMS RD
Provider Second Line Business Mailing Address:
STE. 102
Provider Business Mailing Address City Name:
BARTLESVILLE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74006-8450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-331-1653
Provider Business Mailing Address Fax Number:
918-331-1645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4140 SE ADAMS RD
Provider Second Line Business Practice Location Address:
STE. 102
Provider Business Practice Location Address City Name:
BARTLESVILLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74006-8450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-331-1653
Provider Business Practice Location Address Fax Number:
918-331-1645
Provider Enumeration Date:
04/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HEATH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DME COORDINATOR
Authorized Official Telephone Number:
918-609-7900

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , 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: 200120400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200120400B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 70522221 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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