1295773398 NPI number — MERIDIAN FOOT CLINIC INC

Table of content: (NPI 1295773398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295773398 NPI number — MERIDIAN FOOT CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN FOOT CLINIC 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:
1295773398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13301 N MERIDIAN
Provider Second Line Business Mailing Address:
BLDG 700 SUITE 701
Provider Business Mailing Address City Name:
OKLA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-9369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-751-6152
Provider Business Mailing Address Fax Number:
405-752-5158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13301 N MERIDIAN
Provider Second Line Business Practice Location Address:
BLDG 700 SUITE 701
Provider Business Practice Location Address City Name:
OKLA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-9369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-751-6152
Provider Business Practice Location Address Fax Number:
405-752-5158
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINES
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
OWNER OF CORPORATION
Authorized Official Telephone Number:
405-751-6152

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  113 , 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: 1023011616 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com