1932343464 NPI number — INTERIM HEALTHCARE OF TULSA, INC

Table of content: (NPI 1932343464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932343464 NPI number — INTERIM HEALTHCARE OF TULSA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF TULSA, INC
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:
6
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:
1932343464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2828 E 51ST ST
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74105-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-746-7828
Provider Business Mailing Address Fax Number:
918-746-7819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 E 51ST ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74105-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-746-7828
Provider Business Practice Location Address Fax Number:
918-746-7819
Provider Enumeration Date:
04/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
918-749-9933

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  4256 , 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: 4256 . This is a "OKLAHOMA STATE DEPARTMENT OF HEALTH LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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