1952325557 NPI number — BLANCHARD FAMILY MEDICINE

Table of content: (NPI 1952325557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952325557 NPI number — BLANCHARD FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLANCHARD FAMILY MEDICINE
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:
1952325557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-485-9321
Provider Business Mailing Address Fax Number:
405-485-3154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1019 N COUNCIL AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BLANCHARD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73010-8045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-485-9321
Provider Business Practice Location Address Fax Number:
405-485-3154
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TERRELL
Authorized Official First Name:
GREG
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SR VP, COO
Authorized Official Telephone Number:
405-307-1000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100700690M , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com