1063641280 NPI number — TOTAL RESOURCE GROUP

Table of content: (NPI 1063641280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063641280 NPI number — TOTAL RESOURCE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL RESOURCE GROUP
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:
1063641280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 N WESTERN AVE
Provider Second Line Business Mailing Address:
SUITE 212-A
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73118-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-810-4907
Provider Business Mailing Address Fax Number:
405-810-8682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 N WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 212-A
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73118-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-810-4907
Provider Business Practice Location Address Fax Number:
405-810-8682
Provider Enumeration Date:
07/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CASTEEL
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
CHRISTIE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/MANAGING PARTNER
Authorized Official Telephone Number:
405-810-4907

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7500 , 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: 7500 . This is a "OKLAHOMA STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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