1124131206 NPI number — MR. MARK ANTHONY PRITCHARD BSW

Table of content: MR. MARK ANTHONY PRITCHARD BSW (NPI 1124131206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124131206 NPI number — MR. MARK ANTHONY PRITCHARD BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRITCHARD
Provider First Name:
MARK
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BSW
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:
1124131206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3444
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74802-3444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-258-3040
Provider Business Mailing Address Fax Number:
405-240-5008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 MCKINLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74834-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-258-3040
Provider Business Practice Location Address Fax Number:
405-240-5008
Provider Enumeration Date:
08/16/2006

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: "Y" .

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





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