1639618754 NPI number — OKLAHOMA MOBILE LITHOTRIPTER ASSOCIATES, L.C.

Table of content: DR. ANGELO MANALOTO ARCE D.D.S. (NPI 1104357722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639618754 NPI number — OKLAHOMA MOBILE LITHOTRIPTER ASSOCIATES, L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA MOBILE LITHOTRIPTER ASSOCIATES, L.C.
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:
1639618754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 N PORTLAND AVE
Provider Second Line Business Mailing Address:
SUITE 640
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-604-4160
Provider Business Mailing Address Fax Number:
405-604-4053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 N PORTLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 640
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-604-4160
Provider Business Practice Location Address Fax Number:
405-604-4053
Provider Enumeration Date:
02/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BURCHETT
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
405-604-4160

Provider Taxonomy Codes

  • Taxonomy code: 261QL0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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