1588769780 NPI number — M SAID SADEGHI D.O.

Table of content: M SAID SADEGHI D.O. (NPI 1588769780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588769780 NPI number — M SAID SADEGHI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADEGHI
Provider First Name:
M
Provider Middle Name:
SAID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1588769780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4606 E 67TH ST
Provider Second Line Business Mailing Address:
SUITE 400 BUILDING 7
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74136-4943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-949-9898
Provider Business Mailing Address Fax Number:
918-294-0000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4606 E 67TH ST
Provider Second Line Business Practice Location Address:
SUITE 400 BUILDING 7
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-4943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-949-9898
Provider Business Practice Location Address Fax Number:
918-728-8091
Provider Enumeration Date:
09/13/2006

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: 207W00000X , with the licence number:  3526 , 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: 100735860A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100119820A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com