1437219383 NPI number — KENNETH F DUGGAN CRNA INC

Table of content: (NPI 1437219383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437219383 NPI number — KENNETH F DUGGAN CRNA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNETH F DUGGAN CRNA INC
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:
1437219383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74702-5188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-924-3813
Provider Business Mailing Address Fax Number:
580-924-0909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74701-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-924-3813
Provider Business Practice Location Address Fax Number:
580-924-0909
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUGGAN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
CRNA
Authorized Official Telephone Number:
580-924-3813

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R0045503 , 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: 367500000X . This is a "TAXONOMY CODE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 550564322001 . This is a "BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200109850A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: R0045503 . This is a "LICENSE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 193400000X . This is a "SINGLE SPECIALITY GROUP TAXONOMY CODE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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