1285646018 NPI number — OBSTETRICAL & GYNECOLOGICAL ASSOC OF TULSA

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 1285646018 NPI number — OBSTETRICAL & GYNECOLOGICAL ASSOC OF TULSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OBSTETRICAL & GYNECOLOGICAL ASSOC OF TULSA
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:
ASSOCIATED WOMEN'S SPECIALISTS
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:
1285646018
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:
1705 E 19TH ST
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74104-5405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-742-8847
Provider Business Mailing Address Fax Number:
918-877-1285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 E 19TH ST
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-5405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-742-8847
Provider Business Practice Location Address Fax Number:
918-877-1285
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
LORA
Authorized Official Middle Name:
JOYCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
918-742-8847

Provider Taxonomy Codes

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

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





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