1124108378 NPI number — CARY CARPENTER, M.D. P.C.

Table of content: (NPI 1124108378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124108378 NPI number — CARY CARPENTER, M.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARY CARPENTER, M.D. P.C.
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:
1124108378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHOCTAW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73020-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-390-9600
Provider Business Mailing Address Fax Number:
405-390-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15809 NE 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHOCTAW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73020-8428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-390-9600
Provider Business Practice Location Address Fax Number:
405-390-9400
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
LORRIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
405-808-7765

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  18237 , 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: I00757 . This is a "MEDICARE UPIN - BRUCE STAFFORD, D.O." identifier . This identifiers is of the category "OTHER".
  • Identifier: 200100040A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 249341123 . This is a "MEDICARE INDIVIDUAL P-TAN - CARY CARPENTER M.D." identifier . This identifiers is of the category "OTHER".
  • Identifier: 1861479255 . This is a "NPI - BRUCE STAFFORD, D.O." identifier . This identifiers is of the category "OTHER".
  • Identifier: 241409404 . This is a "MEDICARE INDIVIDUAL P-TAN FOR BRUCE STAFFORD, D.O." identifier . This identifiers is of the category "OTHER".
  • Identifier: 44646 . This is a "BLUE LINCS - BRUCE STAFFORD, DO" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1053311548 . This is a "NPI - CARY CARPENTER M.D." identifier . This identifiers is of the category "OTHER".
  • Identifier: 1164597860 . This is a "NPI - PHYSICIAN ASSISTANT BILLY SANDERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 446-46-7483-001 . This is a "BCBS-BRUCE STAFFORD, DO" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 900522085 . This is a "MEDICARE GROUP P-TAN --CARY CARPENTER MD PC DBA CHOCTAW FAMILY MEDICINE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100113820E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861479255 . This is a "NPI-BRUCE STAFFORD, DO -" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 444745244-001 . This is a "CARY CARPENTER -BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100113820B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: F43282 . This is a "MEDICARE UPIN - CARY CARPENTER M.D." identifier . This identifiers is of the category "OTHER".
  • Identifier: 100113820D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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