1225125966 NPI number — JAMES R PATTERSON CRNA

Table of content: JAMES R PATTERSON CRNA (NPI 1225125966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225125966 NPI number — JAMES R PATTERSON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
JAMES
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1225125966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1664
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKOGEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74402-1664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-947-8585
Provider Business Mailing Address Fax Number:
405-948-6507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 ROCKEFELLER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKOGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74401-5075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-684-2557
Provider Business Practice Location Address Fax Number:
405-948-6507
Provider Enumeration Date:
10/06/2006

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: 367500000X , with the licence number:  67554 , 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: P00287266 . This is a "MEDICARE RR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com