1275657041 NPI number — SHAPEMASTER USA, INC.

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 1275657041 NPI number — SHAPEMASTER USA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAPEMASTER USA, 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:
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:
1275657041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/11/2007
NPI Reactivation Date:
01/31/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7335 S. LEWIS AVE.
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-392-3475
Provider Business Mailing Address Fax Number:
918-392-3471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7335 SOUTH LEWIS AVE.
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-6897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-392-3475
Provider Business Practice Location Address Fax Number:
918-392-3471
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TIPTON
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
918-392-3475

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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