1871522789 NPI number — MRS. DEBRA KAY RUMMEL R.D., L..D.

Table of content: MRS. DEBRA KAY RUMMEL R.D., L..D. (NPI 1871522789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871522789 NPI number — MRS. DEBRA KAY RUMMEL R.D., L..D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUMMEL
Provider First Name:
DEBRA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D., L..D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHANBACHER
Provider Other First Name:
DEBRA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871522789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S. PEORIA AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-588-1900
Provider Business Mailing Address Fax Number:
918-582-6405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 S PEORIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74120-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-588-1900
Provider Business Practice Location Address Fax Number:
918-582-6405
Provider Enumeration Date:
07/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1425 , 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: 200556320 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73-1042545 . This is a "GROUP BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 731042545001 . This is a "GROUP TRICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 73-1042545 . This is a "GROUP COMMUNITY CARE OF OKLAHOMA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100732910-A . This is a "GROUP MEDICAID/SOONERCARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 73-1042545 . This is a "GROUP MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100732910-G . This is a "GROUP MEDICAID/SOONERCARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".