1407818453 NPI number — DR. BART J BORSKY MD

Table of content: DR. BART J BORSKY MD (NPI 1407818453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407818453 NPI number — DR. BART J BORSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORSKY
Provider First Name:
BART
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1407818453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73083-5733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-775-9350
Provider Business Mailing Address Fax Number:
405-775-9360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3048 SW 89TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73159-6385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-703-1302
Provider Business Practice Location Address Fax Number:
405-703-1649
Provider Enumeration Date:
04/05/2006

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: 207L00000X , with the licence number:  18240 , 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: 100017760A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 603123100 . This is a "DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 73145196701 . This is a "BCBS GRP BILLING #" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 111984100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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