1538155627 NPI number — SATHEESH K SHETTY MD PC

Table of content: (NPI 1538155627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538155627 NPI number — SATHEESH K SHETTY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SATHEESH K SHETTY 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:
1538155627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21891
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73156-1891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-834-4274
Provider Business Mailing Address Fax Number:
405-748-4694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3048 SW 89TH ST
Provider Second Line Business Practice Location Address:
SUITE -A
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73159-6385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-834-4274
Provider Business Practice Location Address Fax Number:
405-748-4694
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHETTY
Authorized Official First Name:
SATHEESH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
405-834-4274

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  18820 , 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: 100746630A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 495889260002 . This is a "BCBS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com