1891057766 NPI number — OKLAHOMA SLEEP INSTITUTE CLINIC - STILLWATER

Table of content: MISS ELIZABETH JIMENEZ VILLAGOMEZ (NPI 1790324218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891057766 NPI number — OKLAHOMA SLEEP INSTITUTE CLINIC - STILLWATER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA SLEEP INSTITUTE CLINIC - STILLWATER
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:
1891057766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14000 N PORTLAND AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-4003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-606-2727
Provider Business Mailing Address Fax Number:
405-606-7040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 S PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STILLWATER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74074-4350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-301-8970
Provider Business Practice Location Address Fax Number:
405-606-7040
Provider Enumeration Date:
06/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GOLD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-606-2727

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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