1609029644 NPI number — HEALTHCARE STAT

Table of content: (NPI 1609029644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609029644 NPI number — HEALTHCARE STAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE STAT
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:
1609029644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-659-5656
Provider Business Mailing Address Fax Number:
405-701-5421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1619 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICKASHA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73018-5860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-224-6700
Provider Business Practice Location Address Fax Number:
405-224-6707
Provider Enumeration Date:
11/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BONILLA
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-485-9588

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  R0068442 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP2300X , with the licence number: R0068442 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200226680A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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