1740231752 NPI number — DEACONESS HEALTH SYSTEM LLC

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 1740231752 NPI number — DEACONESS HEALTH SYSTEM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEACONESS HEALTH SYSTEM LLC
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:
ALLIANCEHEALTH DEACONESS
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:
1740231752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 N PORTLAND AVE
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:
73112-2074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-604-6000
Provider Business Mailing Address Fax Number:
405-604-4437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 N PORTLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-2074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-604-6000
Provider Business Practice Location Address Fax Number:
405-604-4437
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LALOR
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR/DELEGATED OFFICIAL
Authorized Official Telephone Number:
615-925-4565

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2294 , 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: 100699370A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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