1487686200 NPI number — DR. ALFRED D JENKINS MD

Table of content: DR. ALFRED D JENKINS MD (NPI 1487686200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487686200 NPI number — DR. ALFRED D JENKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
ALFRED
Provider Middle Name:
D
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:
1487686200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12697 E 51ST ST
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:
74146-6236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-505-3200
Provider Business Mailing Address Fax Number:
918-505-3225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12697 E 51ST ST
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:
74146-6236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-505-3200
Provider Business Practice Location Address Fax Number:
918-505-3225
Provider Enumeration Date:
07/06/2006

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: 207VX0201X , with the licence number:  L4470 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: 058970 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: 32593 , 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: 200674540A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DB701 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 288841401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288841402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01096120 . This is a "RAILROAD MEDICAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com