1912009234 NPI number — VINCENT MICHAEL YOUNG OD PC

Table of content: (NPI 1912009234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912009234 NPI number — VINCENT MICHAEL YOUNG OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINCENT MICHAEL YOUNG OD PC
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:
1912009234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLANCHARD
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73010-0325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-485-3937
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 S. MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLANCHARD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73010-8003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-485-3937
Provider Business Practice Location Address Fax Number:
405-485-3642
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-485-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2441 , 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: 5656891 . This is a "FIRST HEALTH PROVIDER #" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200066400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2569827 . This is a "UNITEDHEALTHCARE PROV#" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: OK2441 . This is a "EYEMED" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 245720 . This is a "COMPBENEFITS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: OK02441 . This is a "VISION BENEFITS ACCT #" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 7530792 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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