1881697761 NPI number — GEORGIANNE M SNOWDEN MD

Table of content: GEORGIANNE M SNOWDEN MD (NPI 1881697761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881697761 NPI number — GEORGIANNE M SNOWDEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNOWDEN
Provider First Name:
GEORGIANNE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1881697761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3330 NW 56TH ST
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-4426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-945-4740
Provider Business Mailing Address Fax Number:
405-945-4751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3330 NW 56TH ST
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-945-4740
Provider Business Practice Location Address Fax Number:
405-945-4751
Provider Enumeration Date:
05/24/2005

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: 2085R0202X , with the licence number:  16539 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 16539 , 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: 100041410A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00144996 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00171214 . This is a "RAILROAD MEDICARE /AI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".