1063704476 NPI number — MIDWEST ONCOLOGY GROUP PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063704476 NPI number — MIDWEST ONCOLOGY GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST ONCOLOGY GROUP 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:
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:
1063704476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 N MIDWEST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDWEST CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73110-4321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-737-8455
Provider Business Mailing Address Fax Number:
405-739-8707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 S CLASSEN AVE
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
MOORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73160-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-799-5366
Provider Business Practice Location Address Fax Number:
405-799-5930
Provider Enumeration Date:
05/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF MEDICAL ONCOLOGY
Authorized Official Telephone Number:
405-737-8455

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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