1366852733 NPI number — MS. SAMANTHA MARIE HUSSEY RD, CSO, LD

Table of content: MS. SAMANTHA MARIE HUSSEY RD, CSO, LD (NPI 1366852733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366852733 NPI number — MS. SAMANTHA MARIE HUSSEY RD, CSO, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSSEY
Provider First Name:
SAMANTHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CSO, LD
Provider Gender Code:
F

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:
1366852733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1122 NE 13TH ST
Provider Second Line Business Mailing Address:
ORI 274
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73117-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-8880
Provider Business Mailing Address Fax Number:
405-208-8732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 N ROBINSON AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73102-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-8880
Provider Business Practice Location Address Fax Number:
405-208-8732
Provider Enumeration Date:
05/06/2014

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: 133V00000X , with the licence number:  1975 , 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)





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