1790814879 NPI number — SARADA JANE MCGAHA BS, CM II, BHRS

Table of content: SARADA JANE MCGAHA BS, CM II, BHRS (NPI 1790814879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790814879 NPI number — SARADA JANE MCGAHA BS, CM II, BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGAHA
Provider First Name:
SARADA
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, CM II, BHRS
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:
1790814879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 SE WASHINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTLESVILLE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74006-7135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-335-1111
Provider Business Mailing Address Fax Number:
918-335-1119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 SE WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTLESVILLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74006-7135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-335-1111
Provider Business Practice Location Address Fax Number:
918-335-1119
Provider Enumeration Date:
03/05/2007

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100732190C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100732190F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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