1922014588 NPI number — OKLAHOMA FOUNDATION FOR DIGESTIVE RESEARCH

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 1922014588 NPI number — OKLAHOMA FOUNDATION FOR DIGESTIVE RESEARCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA FOUNDATION FOR DIGESTIVE RESEARCH
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:
1922014588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N LINCOLN BLVD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-281-4644
Provider Business Mailing Address Fax Number:
405-271-3296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N LINCOLN BLVD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-281-4644
Provider Business Practice Location Address Fax Number:
405-271-3296
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MINER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
BARTON
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
405-271-4644

Provider Taxonomy Codes

  • Taxonomy code: 1744R1102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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