1013071166 NPI number — RUBIS PLASTIC SURGERY, PLLC

Table of content: (NPI 1013071166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013071166 NPI number — RUBIS PLASTIC SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUBIS PLASTIC SURGERY, PLLC
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:
1013071166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10119-A EAST 80TH STREET SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-254-6793
Provider Business Mailing Address Fax Number:
918-254-6796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10119 E 80TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74133-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-254-6793
Provider Business Practice Location Address Fax Number:
918-254-6796
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUBIS
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-254-6793

Provider Taxonomy Codes

  • Taxonomy code: 2082S0105X , with the licence number:  21510 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 21510 , 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: 100749040A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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