1770581001 NPI number — TERESA LYNN TOOMBS CRNA

Table of content: TERESA LYNN TOOMBS CRNA (NPI 1770581001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770581001 NPI number — TERESA LYNN TOOMBS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOMBS
Provider First Name:
TERESA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOOMBS
Provider Other First Name:
TRACY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770581001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK HILL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74451-0579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-772-0990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E DOWNING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-453-2148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  93952 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 4704279215 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 572751 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 88460U . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 154341701 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4308712170 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 166116702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770581001 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82710 . This is a "BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 83898U . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 166116701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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