1689843997 NPI number — GILBRETH FAMILY MEDICINE, PLLC

Table of content: RITA MARIE SANTOS CSW (NPI 1518187079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689843997 NPI number — GILBRETH FAMILY MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GILBRETH FAMILY MEDICINE, PLLC
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:
1689843997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2434 HARVILLE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DUNCAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-252-1918
Provider Business Mailing Address Fax Number:
580-252-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2434 HARVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-252-1918
Provider Business Practice Location Address Fax Number:
580-252-2333
Provider Enumeration Date:
02/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GILBRETH
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
580-252-1918

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  19187 , 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: 100170200C . This is a "MEDICAID/SOONERCARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 467450776003 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100170200D . This is a "MEDICAID/SOONERCARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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