Healthcare Provider Details

I. General information

NPI: 1679724793
Provider Name (Legal Business Name): KENT L MCCAIN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E FRANK PHILLIPS BLVD
BARTLESVILLE OK
74006-2411
US

IV. Provider business mailing address

6767 S YALE AVE # B
TULSA OK
74136-3302
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-1904
  • Fax: 918-331-1103
Mailing address:
  • Phone: 918-488-9992
  • Fax: 918-488-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2498
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number2498
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: