NPI Code Detail JSON Logo

1558805515 NPI number — RECOVERY IN OKLAHOMA LLC

NPI Number: 1558805515
Health Care Provider/Practitioner: RECOVERY IN OKLAHOMA LLC

Information about “1558805515” NPI (RECOVERY IN OKLAHOMA LLC) exists in 1558805515 in HTML format HTML  |  1558805515 in plain Text format TXT  |  1558805515 in PDF (Portable Document Format) PDF  |  1558805515 in an XML format XML  formats.

NPI Number : 1558805515 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558805515",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RECOVERY IN OKLAHOMA LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9179 S 256TH EAST AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROKEN ARROW",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "74014-5536",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "918-928-7303",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4835 S FULTON AVE STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TULSA",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74135-6976",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "918-591-3071",
    "PracticeLocationAddressFaxNumber": "918-615-2261",
    "EnumerationDate": "12/11/2016",
    "LastUpdateDate": "11/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHATTO JOSLIN",
    "AuthorizedOfficialFirstName": "GOOSE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OFFICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "918-591-3071",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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