1922196369 NPI number — THERESA A MURCH D.O.

Table of content: THERESA A MURCH D.O. (NPI 1922196369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922196369 NPI number — THERESA A MURCH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURCH
Provider First Name:
THERESA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1922196369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 SE DEBELL
Provider Second Line Business Mailing Address:
BLDG A
Provider Business Mailing Address City Name:
BARTLESVILLE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-331-2406
Provider Business Mailing Address Fax Number:
918-331-2407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 FRAND PHILLIPS
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
BATLESVILLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-331-2406
Provider Business Practice Location Address Fax Number:
918-331-2407
Provider Enumeration Date:
10/11/2006

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: 207V00000X , with the licence number:  4669 , 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: 200213590A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200039950A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00799207 . This is a "RR MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: DE3229 . This is a "GROUP RR MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com