1831144468 NPI number — NOBLE FAMILY MEDICAL CENTER

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 1831144468 NPI number — NOBLE FAMILY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOBLE FAMILY MEDICAL 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:
1831144468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 N MONTE VISTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820-4612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-310-9510
Provider Business Mailing Address Fax Number:
580-436-4447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E MAGUIRE RD
Provider Second Line Business Practice Location Address:
STE 4000
Provider Business Practice Location Address City Name:
NOBLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73068-9403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-872-9494
Provider Business Practice Location Address Fax Number:
405-872-9464
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER / PHYSICIAN
Authorized Official Telephone Number:
405-872-9494

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20674 , 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: 200015950E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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