1639160708 NPI number — 180 MEDICAL INC

Table of content: (NPI 1639160708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639160708 NPI number — 180 MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
180 MEDICAL INC
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:
1639160708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8516 NW EXPRESSWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73162-6010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-688-2729
Provider Business Mailing Address Fax Number:
888-718-0633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8516 NW EXPRESSWAY
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:
73162-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-688-2729
Provider Business Practice Location Address Fax Number:
888-718-0633
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRIX
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
405-443-2985

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1886232576 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1639160708 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2484093 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8860001 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 052070200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200001560A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625995808 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100096610 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9055500 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001528800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152077716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639160708-000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0578997 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1021600 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200505230A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717660100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9167680 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008068711 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0198056 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79972896 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1026200 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com