1023029667 NPI number — OAKLEY PHCY LLC

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 1023029667 NPI number — OAKLEY PHCY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKLEY PHCY 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:
Provider Other Organization Name Type Code:
6
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:
1023029667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 CENTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLEY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-672-4727
Provider Business Practice Location Address Fax Number:
785-672-4757
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWEITERMAN
Authorized Official First Name:
KEZIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
785-672-4627

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  210079 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1718925 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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