1609893403 NPI number — ACCESS ENDOCRINE, THYROID AND DIABETES CENTER

Table of content: (NPI 1609893403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609893403 NPI number — ACCESS ENDOCRINE, THYROID AND DIABETES CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS ENDOCRINE, THYROID AND DIABETES CENTER
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:
1609893403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268988
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126-8988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-843-2066
Provider Business Mailing Address Fax Number:
405-843-2077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 NW 120TH CT
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73162-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-728-7329
Provider Business Practice Location Address Fax Number:
405-720-2611
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUDE
Authorized Official First Name:
MODHI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-728-7329

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  13262 , 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: 447721027005 . This is a "BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100131440A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37D0471461 . This is a "CLIA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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