1972704252 NPI number — ACCIDENT CARE CLINIC, INC.

Table of content: (NPI 1972704252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972704252 NPI number — ACCIDENT CARE CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCIDENT CARE CLINIC, 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:
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:
1972704252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8505 S. WESTERN AVE
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:
73139-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-636-4078
Provider Business Mailing Address Fax Number:
405-636-4079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8505 S WESTERN AVE
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:
73139-9209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-636-4078
Provider Business Practice Location Address Fax Number:
405-636-4079
Provider Enumeration Date:
05/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOGGS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-636-4078

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3421 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 3462 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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