1083781058 NPI number — MERCY HEALTH NETWORK OF THE SOUTHERN REGION, INC.

Table of content: (NPI 1083781058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083781058 NPI number — MERCY HEALTH NETWORK OF THE SOUTHERN REGION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH NETWORK OF THE SOUTHERN REGION, 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:
MERCY HEALTH DAVIS
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:
1083781058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 W MEMORIAL RD
Provider Second Line Business Mailing Address:
SUITE #141, ATTENTION BECKY
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-936-5800
Provider Business Mailing Address Fax Number:
405-936-5810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73030-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-369-2803
Provider Business Practice Location Address Fax Number:
580-369-3497
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
580-220-6611

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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