1992927453 NPI number — MCCURDY RABLE SURGICAL CLINIC INC

Table of content: LESLIE PHU ND, LAC (NPI 1831964477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992927453 NPI number — MCCURDY RABLE SURGICAL CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCURDY RABLE SURGICAL CLINIC INC
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:
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:
1992927453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 EAST ROBINSON
Provider Second Line Business Mailing Address:
SUITE 2300
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73071-6671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-329-4102
Provider Business Mailing Address Fax Number:
405-364-3476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 EAST ROBINSON
Provider Second Line Business Practice Location Address:
SUITE 2300
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73071-6671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-329-4102
Provider Business Practice Location Address Fax Number:
405-364-3476
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCURDY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-329-4102

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  17833 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 9306 , 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: P00072417 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00397767 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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