1245477306 NPI number — ARDESHIR F. NIA, MD, PC

Table of content: (NPI 1346384104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245477306 NPI number — ARDESHIR F. NIA, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARDESHIR F. NIA, MD, PC
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:
1245477306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 E LINCOLN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDABEL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74745-7342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-286-4300
Provider Business Mailing Address Fax Number:
580-286-5530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 E LINCOLN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDABEL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74745-7342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-286-4300
Provider Business Practice Location Address Fax Number:
580-286-5530
Provider Enumeration Date:
01/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NIA
Authorized Official First Name:
ARDESHIR
Authorized Official Middle Name:
FAGHIH
Authorized Official Title or Position:
OWNER/ PRESIDENT
Authorized Official Telephone Number:
580-286-4300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  24784 , 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: DP4346 . This is a "RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200234100A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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