1053437251 NPI number — JAMES DENNIS MEDICAL FOUNDATION INC

Table of content: (NPI 1053437251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053437251 NPI number — JAMES DENNIS MEDICAL FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES DENNIS MEDICAL FOUNDATION 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:
Provider Other Organization Name Type Code:
6
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:
1053437251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1153 CHEROKEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAKITA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73771-9520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-594-2292
Provider Business Mailing Address Fax Number:
580-594-2534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1153 CHEROKEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKITA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73771-5095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-594-2292
Provider Business Practice Location Address Fax Number:
580-594-2534
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
580-594-2292

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH2701-2701 , 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)





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