1508847682 NPI number — MR. RICHARD HARLEN SWINK PHD

Table of content: MR. RICHARD HARLEN SWINK PHD (NPI 1508847682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508847682 NPI number — MR. RICHARD HARLEN SWINK PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWINK
Provider First Name:
RICHARD
Provider Middle Name:
HARLEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWINK
Provider Other First Name:
RICHARD
Provider Other Middle Name:
HARLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508847682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 E 19TH ST
Provider Second Line Business Mailing Address:
BLDG 103
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-6627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-341-3085
Provider Business Mailing Address Fax Number:
405-341-0128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 E 19TH ST
Provider Second Line Business Practice Location Address:
BLDG 103
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-6627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-341-3085
Provider Business Practice Location Address Fax Number:
405-341-0128
Provider Enumeration Date:
11/07/2005

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: 103T00000X , with the licence number:  124 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 124 , 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: 100839380A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100839380B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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