1346683026 NPI number — AMY BETH BRADSHAW MPH

Table of content: AMY BETH BRADSHAW MPH (NPI 1346683026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346683026 NPI number — AMY BETH BRADSHAW MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADSHAW
Provider First Name:
AMY
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPH
Provider Gender Code:
F

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:
1346683026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 S PEORIA 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:
74120-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-587-9471
Provider Business Mailing Address Fax Number:
918-560-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 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:
74114-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-712-4301
Provider Business Practice Location Address Fax Number:
918-560-1399
Provider Enumeration Date:
04/11/2013

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: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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