1174662308 NPI number — VINODH JEEVANANTHAM MD

Table of content: VINODH JEEVANANTHAM MD (NPI 1174662308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174662308 NPI number — VINODH JEEVANANTHAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEEVANANTHAM
Provider First Name:
VINODH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1174662308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 S DOUGLAS BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73150-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-737-7000
Provider Business Mailing Address Fax Number:
405-272-2898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 S DOUGLAS BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73150-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-737-7000
Provider Business Practice Location Address Fax Number:
405-272-2898
Provider Enumeration Date:
02/05/2007

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: 208M00000X , with the licence number:  2007-01011 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 30512 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1992885545 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199206 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 145HT . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: Q0052M , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200545090A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5906676 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9164064 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3810009020 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810599 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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