1437222734 NPI number — STATE OF OKLAHOMA

Table of content: CHARLES FRANCIS LANZILLO III M.D. (NPI 1417120312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437222734 NPI number — STATE OF OKLAHOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE 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:
1437222734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1222 10TH ST SUITE 211
Provider Second Line Business Mailing Address:
NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Provider Business Mailing Address City Name:
WOODWARD
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73801-3156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-571-3217
Provider Business Mailing Address Fax Number:
580-256-8609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 CHOCTAW
Provider Second Line Business Practice Location Address:
NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
ALVA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-327-1112
Provider Business Practice Location Address Fax Number:
580-327-3067
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
TRUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
580-571-3233

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100706980A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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