1073686564 NPI number — THAYNE A HEDGES REGIONAL SPEECH AND HEARING CENTER INC

Table of content: (NPI 1073686564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073686564 NPI number — THAYNE A HEDGES REGIONAL SPEECH AND HEARING CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THAYNE A HEDGES REGIONAL SPEECH AND HEARING CENTER 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:
1073686564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 E RANDOLPH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENID
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73701-4670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-234-3734
Provider Business Mailing Address Fax Number:
580-234-2615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 E RANDOLPH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73701-4670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-234-3734
Provider Business Practice Location Address Fax Number:
580-234-2615
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALL
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXEC DIRECTOR
Authorized Official Telephone Number:
580-234-3734

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  90 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2571 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 2181 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 114 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2948 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 53 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100664980A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100757400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100662450B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100653300B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100659190A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100757400E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100660610A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100757400B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200013580A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100757400C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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