1033248356 NPI number — MAYES COUNTY SPEECH THERAPY SERVICES P.L.L.C.

Table of content: (NPI 1033248356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033248356 NPI number — MAYES COUNTY SPEECH THERAPY SERVICES P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYES COUNTY SPEECH THERAPY SERVICES P.L.L.C.
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:
1033248356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 S ELLIOTT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRYOR
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74361-6411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-825-4837
Provider Business Mailing Address Fax Number:
918-825-4644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 S ELLIOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRYOR
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74361-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-825-4837
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN HORN
Authorized Official First Name:
TINA
Authorized Official Middle Name:
MICHELL
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST -OWNER
Authorized Official Telephone Number:
918-640-6468

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3168 , 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)





Copyright © 2007-2025 www.npivalidator.com