1801170212 NPI number — OKLAHOMA SLEEP INSTITUTE CLINIC - MWC

Table of content: (NPI 1801170212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801170212 NPI number — OKLAHOMA SLEEP INSTITUTE CLINIC - MWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA SLEEP INSTITUTE CLINIC - MWC
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:
1801170212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13900 WIRELESS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-606-2727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8121 NATIONAL AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73110-7530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-443-3594
Provider Business Practice Location Address Fax Number:
405-606-7040
Provider Enumeration Date:
10/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GOLD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-606-2727

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  R0058479 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: R0058479 , 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)





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