1114962396 NPI number — WILLIAM J PERKINS MD PC

Table of content: (NPI 1114962396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114962396 NPI number — WILLIAM J PERKINS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM J PERKINS MD PC
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:
1114962396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 504714
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63150-4714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-991-1101
Provider Business Mailing Address Fax Number:
903-787-5854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 NW 50TH ST
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:
73112-5627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-991-1101
Provider Business Practice Location Address Fax Number:
903-787-5854
Provider Enumeration Date:
06/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-834-9464

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  11975 , 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: 445485972001 . This is a "BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200282770B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB1476 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".