1639141724 NPI number — RITA WESTENHAVER DO

Table of content: RITA WESTENHAVER DO (NPI 1639141724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639141724 NPI number — RITA WESTENHAVER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTENHAVER
Provider First Name:
RITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLATER
Provider Other First Name:
RITA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639141724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8115 S MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74133-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-254-6315
Provider Business Mailing Address Fax Number:
918-403-6315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8115 S MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74133-4331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-254-6315
Provider Business Practice Location Address Fax Number:
918-403-6315
Provider Enumeration Date:
02/03/2006

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: 207Q00000X , with the licence number:  2731 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 2731 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100710600E . This is a "GROUP OK MEDICAID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 731438253 . This is a "GROUP MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2731 . This is a "OKLAHOMA MEDICAL LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 05-34090 . This is a "LICENSE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100102280A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731438253-007 . This is a "GROUP BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J0677 . This is a "TEXAS MEDICAL LICENSE NUM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com