1255318234 NPI number — STEPHEN C KHOURY DO

Table of content: STEPHEN C KHOURY DO (NPI 1255318234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255318234 NPI number — STEPHEN C KHOURY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHOURY
Provider First Name:
STEPHEN
Provider Middle Name:
C
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:
1255318234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 W UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74701-3094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-924-5500
Provider Business Mailing Address Fax Number:
580-924-1991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 W UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74701-3094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-924-5500
Provider Business Practice Location Address Fax Number:
580-924-1991
Provider Enumeration Date:
12/29/2005

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: 207Q00000X , with the licence number:  M6232 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 3769 , 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: 100131660 . This is a "OHCA OKLAHOMA HEALTHCARE AUTHORITY" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 28307 . This is a "OBNDD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 3769 . This is a "OKLAHOMA STATE LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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