1306200548 NPI number — MR. JONATHAN PAUL ROHLOFF

Table of content: MR. JONATHAN PAUL ROHLOFF (NPI 1306200548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306200548 NPI number — MR. JONATHAN PAUL ROHLOFF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROHLOFF
Provider First Name:
JONATHAN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1306200548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2259 GREEN MEADOWS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALESTER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74501-3245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-320-0715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 E CLARK BASS BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MCALESTER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74501-4269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-421-6795
Provider Business Practice Location Address Fax Number:
918-421-6791
Provider Enumeration Date:
04/13/2016

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: 207Q00000X , with the licence number:  6242 , 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)