1245353713 NPI number — TRICITIES MEDICAL & SURGICAL

Table of content: (NPI 1245353713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245353713 NPI number — TRICITIES MEDICAL & SURGICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRICITIES MEDICAL & SURGICAL
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:
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:
1245353713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1221
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEWOKA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74884-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-257-6272
Provider Business Mailing Address Fax Number:
405-257-6273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 S INDIAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEWOKA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74884-9781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-257-6272
Provider Business Practice Location Address Fax Number:
405-257-6273
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADRON
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
405-257-6272

Provider Taxonomy Codes

  • Taxonomy code: 173000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100737390A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200037050A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902885817 . This is a "NPI FOR TRUDI FREELAND" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200007490A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com