1306396577 NPI number — OPTIMUM CARE HOSPITALIST GROUP PLLC

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 1306396577 NPI number — OPTIMUM CARE HOSPITALIST GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMUM CARE HOSPITALIST GROUP PLLC
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:
1306396577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 E MEMORIAL RD STE A4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73114-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-777-4726
Provider Business Mailing Address Fax Number:
405-390-7409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 E MEMORIAL RD STE A4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73114-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-777-4726
Provider Business Practice Location Address Fax Number:
405-390-7409
Provider Enumeration Date:
10/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SANAULLAH
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-376-9544

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  28187 , 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)





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