1881039014 NPI number — GROUP LLC

Table of content: (NPI 1881039014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881039014 NPI number — GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROUP LLC
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:
THE BAM ANESTHESIA GROUP
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:
1881039014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 108835
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73101-8835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-418-4800
Provider Business Mailing Address Fax Number:
405-418-4820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N LINCOLN BLVD STE 150
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:
73104-3253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-418-4800
Provider Business Practice Location Address Fax Number:
405-418-4820
Provider Enumeration Date:
05/01/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHRISTENSEN
Authorized Official First Name:
R.
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-418-4800

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200487290A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 617740000 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: DU1302 . This is a "RR MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".