1073787404 NPI number — MS. PATRICE D. RILEY MHR/MRC

Table of content: MS. PATRICE D. RILEY MHR/MRC (NPI 1073787404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073787404 NPI number — MS. PATRICE D. RILEY MHR/MRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY
Provider First Name:
PATRICE
Provider Middle Name:
D.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MHR/MRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMPKINS
Provider Other First Name:
PAT
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MHR/MRC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073787404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4528 S SHERIDAN RD STE 113
Provider Second Line Business Mailing Address:
4528 S. SHERIDAN RD, STE 113, TULSA OK 74145
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74145-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-282-5363
Provider Business Mailing Address Fax Number:
918-282-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
448 36TH AVE NW STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73072-4743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-573-7792
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 21448 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1245549567 . This is a "OKLAHOMA HEALTH CARE AUTHORITY" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200242130A . This is a "OHCA SOONERCARE PROVIDER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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