1962708461 NPI number — OU MEDICINE INC.

Table of content: (NPI 1962708461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962708461 NPI number — OU MEDICINE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OU MEDICINE 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:
JIMMY EVEREST CANCER CENTER 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:
1962708461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 CHILDRENS AVE STE 7300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104-4637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-1047
Provider Business Mailing Address Fax Number:
405-271-4301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 CHILDRENS AVE STE 7300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-1047
Provider Business Practice Location Address Fax Number:
405-271-4301
Provider Enumeration Date:
01/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WINTERS
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PHARMACY
Authorized Official Telephone Number:
405-738-7943

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3726481 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200021910H , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".