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1679231229 NPI number — IMMEDIATE CARE OF OKLAHOMA - SE OKC LAB

NPI Number: 1679231229
Health Care Provider/Practitioner: IMMEDIATE CARE OF OKLAHOMA - SE OKC LAB

Information about “1679231229” NPI (IMMEDIATE CARE OF OKLAHOMA - SE OKC LAB) exists in 1679231229 in HTML format HTML  |  1679231229 in plain Text format TXT  |  1679231229 in PDF (Portable Document Format) PDF  |  1679231229 in an XML format XML  formats.

NPI Number : 1679231229 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679231229",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IMMEDIATE CARE OF OKLAHOMA - SE OKC LAB",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5701 SE 74TH STREET",
    "SecondLineMailingAddress": "SUITE E",
    "MailingAddressCityName": "OKLAHOMA CITY",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73135-1110",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "405-600-6869",
    "MailingAddressFaxNumber": "405-600-6978",
    "FirstLinePracticeLocationAddress": "5700 SE 74TH STREET",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "OKLAHOMA CITY",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "73135-1087",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "405-400-1096",
    "PracticeLocationAddressFaxNumber": "405-600-6978",
    "EnumerationDate": "12/01/2021",
    "LastUpdateDate": "12/01/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PENWELL",
    "AuthorizedOfficialFirstName": "KEVIN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT/COM",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.O.",
    "AuthorizedOfficialTelephoneNumber": "405-600-6869",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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