1598044505 NPI number — OKLAHOMA PROTON RADIATION ONCOLOGY GROUP PC

Table of content: DR. LUISA JOSEFINA MUJICA M.D. (NPI 1679542286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598044505 NPI number — OKLAHOMA PROTON RADIATION ONCOLOGY GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA PROTON RADIATION ONCOLOGY GROUP 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:
1598044505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 871678
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64187-1678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-773-6700
Provider Business Mailing Address Fax Number:
405-720-3910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 W MEMORIAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73142-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-773-6700
Provider Business Practice Location Address Fax Number:
405-720-3910
Provider Enumeration Date:
08/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUG
Authorized Official First Name:
EUGEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT/SECRETARY
Authorized Official Telephone Number:
405-773-6700

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  28305 , 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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