MEDICARE: RITA BANKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1316367055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA BANKS

Provider Business Mailing Address
First Line	:	PO BOX 720918
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73172-0918
Country	:	US
Telephone Number	:	405-623-8630
Fax Number	:	405-972-5284

Provider Business Practice Location Address
First Line	:	11901 BLUE MOON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1014
Country	:	US
Telephone Number	:	405-623-8630
Fax Number	:	405-506-0468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	08/08/2024

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Directions to “ RITA BANKS ” Practice Location

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