Healthcare Provider Details

I. General information

NPI: 1386173672
Provider Name (Legal Business Name): MR. JOHN A HALE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 MEADOWS CROSSING DRIVE
EDMOND OK
73012
US

IV. Provider business mailing address

19100 MEADOWS CROSSING DR
EDMOND OK
73012-2804
US

V. Phone/Fax

Practice location:
  • Phone: 405-706-4361
  • Fax:
Mailing address:
  • Phone: 405-706-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2403
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: