1013225762 NPI number — MRS. CRYSTAL LEE DOWNS MASTERS VOC REHAB

Table of content: MRS. CRYSTAL LEE DOWNS MASTERS VOC REHAB (NPI 1013225762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013225762 NPI number — MRS. CRYSTAL LEE DOWNS MASTERS VOC REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWNS
Provider First Name:
CRYSTAL
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTERS VOC REHAB
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BACHELORS VOC REHAB
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013225762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14814 N 60TH EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLINSVILLE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74021-5728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-991-3317
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 E 66TH PL
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:
74136-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-293-2500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2010

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: 101Y00000X , with the licence number:  E080280977 , 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)





Copyright © 2007-2024 www.npivalidator.com