Healthcare Provider Details

I. General information

NPI: 1356621908
Provider Name (Legal Business Name): NRHS BREAST CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER
NORMAN OK
73071-6404
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-2600
  • Fax: 405-307-2625
Mailing address:
  • Phone: 405-307-6661
  • Fax: 405-307-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREG TERRELL
Title or Position: SR VP, COO
Credential:
Phone: 405-307-1000