1659623627 NPI number — A STEP BEYOND THE REST: HEALTHCARE INNOVATIONS

Table of content: (NPI 1659623627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659623627 NPI number — A STEP BEYOND THE REST: HEALTHCARE INNOVATIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A STEP BEYOND THE REST: HEALTHCARE INNOVATIONS
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:
1659623627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26
Provider Second Line Business Mailing Address:
1 MEDICAL PLAZA
Provider Business Mailing Address City Name:
RATLIFF CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73481-0026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-856-2102
Provider Business Mailing Address Fax Number:
580-856-3757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
BOX 26
Provider Business Practice Location Address City Name:
RATLIFF CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73481-0026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-856-2102
Provider Business Practice Location Address Fax Number:
580-856-3607
Provider Enumeration Date:
10/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RECKER
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE PROPRIETOR/OWNER
Authorized Official Telephone Number:
580-856-2102

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  85617 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 85617 , 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)

  • Identifier: 1467753004 . This is a "AUTHORIZED PROVIDER NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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