1952546962 NPI number — OKLAHOMA ONCOLOGY AND HEMATOLGY PC

Table of content: (NPI 1952546962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952546962 NPI number — OKLAHOMA ONCOLOGY AND HEMATOLGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA ONCOLOGY AND HEMATOLGY PC
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:
CANCER CARE ASSOCIATES SPECIALTY PHARMACY
Provider Other Organization Name Type Code:
3
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:
1952546962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 W MEMORIAL RD
Provider Second Line Business Mailing Address:
STE 138
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-936-2825
Provider Business Mailing Address Fax Number:
405-936-2895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 W MEMORIAL RD
Provider Second Line Business Practice Location Address:
STE 138
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73134-1785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-936-2825
Provider Business Practice Location Address Fax Number:
405-936-2895
Provider Enumeration Date:
12/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BUKOFZER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
918-499-2153

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  15348 , 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: 100744480 B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3725629 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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