1891082152 NPI number — REITZ NEUROLOGY PLLC

Table of content: (NPI 1891082152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891082152 NPI number — REITZ NEUROLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REITZ NEUROLOGY 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:
1891082152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 W WILLOW RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ENID
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73703-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-237-0549
Provider Business Mailing Address Fax Number:
580-237-7851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 W WILLOW RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73703-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-237-0549
Provider Business Practice Location Address Fax Number:
580-237-7851
Provider Enumeration Date:
07/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REITZ
Authorized Official First Name:
ROLFE
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
580-237-0549

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  13807 , 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: 130005602 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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