1104968601 NPI number — MR. ROBERT MALCOLM KAY V BS

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 1104968601 NPI number — MR. ROBERT MALCOLM KAY V BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAY
Provider First Name:
ROBERT
Provider Middle Name:
MALCOLM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
V
Provider Credential Text:
BS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1104968601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 S PEORIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74120-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-587-9471
Provider Business Mailing Address Fax Number:
918-560-0137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 N DENVER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74103-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-582-1200
Provider Business Practice Location Address Fax Number:
918-581-0777
Provider Enumeration Date:
02/12/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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