1891861449 NPI number — SARAH EMILEE WOOD DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891861449 NPI number — SARAH EMILEE WOOD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
SARAH
Provider Middle Name:
EMILEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDERS
Provider Other First Name:
SARAH
Provider Other Middle Name:
EMILEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1891861449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306
Provider Second Line Business Mailing Address:
136 W FOLEY
Provider Business Mailing Address City Name:
EUFAULA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-618-4000
Provider Business Mailing Address Fax Number:
918-473-1148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHECOTAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-473-1148
Provider Business Practice Location Address Fax Number:
918-473-0250
Provider Enumeration Date:
11/27/2006

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: 207Q00000X , with the licence number:  3217 , 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: 100206420G , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100206420F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100206420H , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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