1841623444 NPI number — MARY E SUMMERS BS/BHRS

Table of content: MARY E SUMMERS BS/BHRS (NPI 1841623444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841623444 NPI number — MARY E SUMMERS BS/BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUMMERS
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS/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:
1841623444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3705 W DETROIT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012-2183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-361-4664
Provider Business Mailing Address Fax Number:
800-260-7966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4122 W 55TH PLACE S.
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74107-9108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-486-9996
Provider Business Practice Location Address Fax Number:
800-260-7966
Provider Enumeration Date:
08/19/2013

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: 225C00000X , with the licence number:  BHRS CERTIFICATION , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 6100 , 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: PENDING , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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