1003073040 NPI number — STATE OF OKLAHOMA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003073040 NPI number — STATE OF OKLAHOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF OKLAHOMA
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:
CLAREMORE VETERANS CENTER
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:
1003073040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 W BLUE STARR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMORE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74017-2544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-342-5432
Provider Business Mailing Address Fax Number:
918-342-5432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 W BLUE STARR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74017-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-342-5432
Provider Business Practice Location Address Fax Number:
918-342-5432
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VEITCH
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
IT STRATEGIST
Authorized Official Telephone Number:
405-523-4091

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 29-3298 , 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: 2176128 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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