1851621213 NPI number — CLEVELAND NEPHROLOGISTS, PLLC

Table of content: (NPI 1851621213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851621213 NPI number — CLEVELAND NEPHROLOGISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND NEPHROLOGISTS, 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:
6
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:
1851621213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1561 N. PORTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73071-6621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-329-3830
Provider Business Mailing Address Fax Number:
405-329-3791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1059 SE 82ND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73149-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-329-3830
Provider Business Practice Location Address Fax Number:
405-329-3791
Provider Enumeration Date:
01/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LLANDEROSOS
Authorized Official First Name:
OSWALD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
405-329-3830

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37-2579 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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