1740576842 NPI number — PAMELA R. GARNER D.O. PLLC

Table of content: (NPI 1740576842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740576842 NPI number — PAMELA R. GARNER D.O. PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMELA R. GARNER D.O. 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:
1740576842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 4TH ST
Provider Second Line Business Mailing Address:
SUITE K
Provider Business Mailing Address City Name:
ALVA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73717-2372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-327-6880
Provider Business Mailing Address Fax Number:
580-327-6891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 4TH ST
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
ALVA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73717-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-327-6880
Provider Business Practice Location Address Fax Number:
580-327-6891
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GARNER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
580-327-6880

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  4409 , 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: 1164561353 . This is a "NPI-PERSONAL" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com