Healthcare Provider Details

I. General information

NPI: 1942589924
Provider Name (Legal Business Name): LANE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13313 N MERIDIAN AVE # A3
OKLAHOMA CITY OK
73120-8380
US

IV. Provider business mailing address

13313 N MERIDIAN AVE # A3
OKLAHOMA CITY OK
73120-8380
US

V. Phone/Fax

Practice location:
  • Phone: 405-753-9600
  • Fax: 405-753-9601
Mailing address:
  • Phone: 405-753-9600
  • Fax: 405-753-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number13287
License Number StateOK

VIII. Authorized Official

Name: KIM BIGGS
Title or Position: MANAGER
Credential:
Phone: 405-753-9600