Healthcare Provider Details

I. General information

NPI: 1316481583
Provider Name (Legal Business Name): RICKY BATES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N LOTTIE AVE
OKLAHOMA CITY OK
73117-2051
US

IV. Provider business mailing address

1311 N LOTTIE AVE
OKLAHOMA CITY OK
73117-2051
US

V. Phone/Fax

Practice location:
  • Phone: 405-600-3074
  • Fax: 405-605-8120
Mailing address:
  • Phone: 405-600-3074
  • Fax: 405-605-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: