1033243415 NPI number — AMERICAN COMMUNICATION & REHABILITATION

Table of content: (NPI 1033243415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033243415 NPI number — AMERICAN COMMUNICATION & REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN COMMUNICATION & REHABILITATION
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:
1033243415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 W 40TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAND SPRINGS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74063-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-241-2110
Provider Business Mailing Address Fax Number:
918-241-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 W 40TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAND SPRINGS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74063-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-241-2110
Provider Business Practice Location Address Fax Number:
918-241-2112
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-607-0292

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100796150C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100796150E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 629736000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100796150B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100796150A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100796150D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200305120A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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