Healthcare Provider Details

I. General information

NPI: 1902150600
Provider Name (Legal Business Name): EDWARD JOSEPH AIRINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W 13TH ST
ATOKA OK
74525-3712
US

IV. Provider business mailing address

RR 1 BOX 28A
TUPELO OK
74572-9705
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-5555
  • Fax: 580-889-1925
Mailing address:
  • Phone: 580-927-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: