1659547248 NPI number — B.L. CARPENTER, M.D. CLINIC, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659547248 NPI number — B.L. CARPENTER, M.D. CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B.L. CARPENTER, M.D. CLINIC, PLLC
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:
B.L. CARPENTER, M.D.
Provider Other Organization Name Type Code:
3
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:
1659547248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 N WEIGLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATONGA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73772-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-623-7444
Provider Business Mailing Address Fax Number:
580-623-7447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 N WEIGLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATONGA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73772-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-623-7444
Provider Business Practice Location Address Fax Number:
580-623-7447
Provider Enumeration Date:
05/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
BYRON
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/SOLE PROPRIATOR
Authorized Official Telephone Number:
580-623-7444

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  21320 , 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: 100230090A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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