1619005865 NPI number — OK FOOT & ANKLE SPECIALISTS

Table of content: (NPI 1619005865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619005865 NPI number — OK FOOT & ANKLE SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OK FOOT & ANKLE SPECIALISTS
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:
6
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:
1619005865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9315 S PENNSYLVANIA AVE STE A
Provider Second Line Business Mailing Address:
OKLAHOMA FOOT & ANKLE SPECIALISTS
Provider Business Mailing Address City Name:
OKC
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73159-6913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-691-9004
Provider Business Mailing Address Fax Number:
405-691-9003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9315 S PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
STE 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:
73159-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-691-9004
Provider Business Practice Location Address Fax Number:
405-691-9003
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KARI
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
BILLING/CREDENTIALING
Authorized Official Telephone Number:
405-691-9004

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  233 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 289 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200034090B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200330230A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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