1629529771 NPI number — BLACKWELL HOSPITAL TRUST AUTHORITY

Table of content: JEANNINE E WYKE D. M. D. (NPI 1861557225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629529771 NPI number — BLACKWELL HOSPITAL TRUST AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACKWELL HOSPITAL TRUST AUTHORITY
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:
1629529771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-533-5288
Provider Business Mailing Address Fax Number:
405-533-2032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 S 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKWELL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74631-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-363-2311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BLESSEN
Authorized Official First Name:
DOUG
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
580-363-2311

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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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