1821255233 NPI number — DAVID C JENNINGS DO PLLC

Table of content: (NPI 1821255233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821255233 NPI number — DAVID C JENNINGS DO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID C JENNINGS DO PLLC
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:
1821255233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7107 S YALE AVE
Provider Second Line Business Mailing Address:
PMB 187
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74136-6308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-615-6581
Provider Business Mailing Address Fax Number:
918-893-1242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6161 S YALE AVE
Provider Second Line Business Practice Location Address:
REHABILITATION UNIT
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-615-6581
Provider Business Practice Location Address Fax Number:
918-893-1242
Provider Enumeration Date:
05/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JENNINGS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-615-6581

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  4593 , 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)