1326706565 NPI number — FOOT AND ANKLE SPECIALIST OF OKLAHOMA

Table of content: DR. JAY MICHAEL ALBRECHT PH.D. (NPI 1336569748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326706565 NPI number — FOOT AND ANKLE SPECIALIST OF OKLAHOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE SPECIALIST OF OKLAHOMA
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:
1326706565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4538 S HARVARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74135-2906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4538 S HARVARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-570-7264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KALVIG
Authorized Official First Name:
KRISTOFOR
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
515-570-7264

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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