1497942635 NPI number — MR. OTTO ARTHUR CARGILL MFT ADC

Table of content: MR. OTTO ARTHUR CARGILL MFT ADC (NPI 1497942635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497942635 NPI number — MR. OTTO ARTHUR CARGILL MFT ADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARGILL
Provider First Name:
OTTO
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MFT ADC
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:
1497942635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10300 BIRKENHEAD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUKON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73099-7504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-205-9677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7905 E US HIGHWAY 66
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL RENO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73036-9225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-262-0202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2007

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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