1780797456 NPI number — MARTHA MICHELLE BARLOW D.O.

Table of content: MARTHA MICHELLE BARLOW D.O. (NPI 1780797456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780797456 NPI number — MARTHA MICHELLE BARLOW D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARLOW
Provider First Name:
MARTHA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1780797456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S BLISS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAHLEQUAH
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74464-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-458-3100
Provider Business Mailing Address Fax Number:
918-458-3610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S BLISS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-458-3100
Provider Business Practice Location Address Fax Number:
918-458-3610
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  3248 , 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: CG9653 . This is a "GROUP RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100699880B . This is a "GROUP MEDICAID NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 08175316 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100137980C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: H37015401 . This is a "GROUP MEDICARE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 730777479002 . This is a "GROUP BLUECROSSBLUESHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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