1750607651 NPI number — PINNACLE HEALTHCARE OF OKLAHOMA LLP

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 1750607651 NPI number — PINNACLE HEALTHCARE OF OKLAHOMA LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTHCARE OF OKLAHOMA LLP
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:
6
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:
1750607651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4140 SE ADAMS RD
Provider Second Line Business Mailing Address:
STE. 102
Provider Business Mailing Address City Name:
BARTLESVILLE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74006-8450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-331-1653
Provider Business Mailing Address Fax Number:
918-331-1645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4140 SE ADAMS RD
Provider Second Line Business Practice Location Address:
STE. 102
Provider Business Practice Location Address City Name:
BARTLESVILLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74006-8450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-331-1653
Provider Business Practice Location Address Fax Number:
918-331-1645
Provider Enumeration Date:
04/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HEATH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DME COORDINATOR
Authorized Official Telephone Number:
918-609-7900

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , 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: 200120400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200120400B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 70522221 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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