1225129398 NPI number — COURTNEY ALLISON MERCER BSRT RDMS

Table of content: COURTNEY ALLISON MERCER BSRT RDMS (NPI 1225129398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225129398 NPI number — COURTNEY ALLISON MERCER BSRT RDMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCER
Provider First Name:
COURTNEY
Provider Middle Name:
ALLISON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSRT RDMS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLDWELL
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
ALLISON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225129398
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:
5780 S PEORIA AVENUE
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:
74105-7857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-858-5200
Provider Business Mailing Address Fax Number:
918-582-4921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 S PEORIA AVE
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:
74120-4495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-587-1101
Provider Business Practice Location Address Fax Number:
918-592-3024
Provider Enumeration Date:
09/27/2006

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: 2471S1302X , with the licence number:  100804 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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