1235124330 NPI number — RICK G MCKINNEY DO

Table of content: RICK G MCKINNEY DO (NPI 1235124330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235124330 NPI number — RICK G MCKINNEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINNEY
Provider First Name:
RICK
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1235124330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
04/21/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E ROBINSON ST
Provider Second Line Business Mailing Address:
SUITE 2100
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73071-6697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-447-8808
Provider Business Mailing Address Fax Number:
405-447-2505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E ROBINSON ST
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73071-6697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-447-8808
Provider Business Practice Location Address Fax Number:
405-447-2505
Provider Enumeration Date:
09/14/2005

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: 207RX0202X , with the licence number:  2590 , 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: O0405 . This is a "EMDEON" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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