1184512519 NPI number — MIND INSPIRING PHYSICIAN GROUP 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 1184512519 NPI number — MIND INSPIRING PHYSICIAN GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIND INSPIRING PHYSICIAN GROUP 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:
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:
1184512519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8336 S LEWIS AVE
Provider Second Line Business Mailing Address:
#605
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74137-1525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-944-4038
Provider Business Mailing Address Fax Number:
918-398-9257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7718 E 91ST ST
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
TUSLA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74133-6018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-944-4038
Provider Business Practice Location Address Fax Number:
918-398-9257
Provider Enumeration Date:
06/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
LAFROMBOISE
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
918-500-2790

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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