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NPI Code Detail

MEDICARE: ADRIAN LAYNE GOLD

MEDICARE: ADRIAN LAYNE GOLD
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
1171M00000XCase Manager/Care Coordinator
2104100000XSocial Worker

General Provider Information

NPI Number : 1336440296
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADRIAN LAYNE GOLD
Provider Business Mailing Address
First Line : 112 W MAIN ST
Second Line :
City : PURCELL
State : OK
Zip : 73080-4220
Country : US
Telephone Number : 405-527-1785
Fax Number : 405-527-1084
Provider Business Practice Location Address
First Line : 314 S BROADWAY AVE STE 200
Second Line :
City : ADA
State : OK
Zip : 74820-5818
Country : US
Telephone Number : 580-235-0210
Fax Number : 580-235-0211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2010
Last Update Date : 05/12/2011

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Directions to “ ADRIAN LAYNE GOLD ” Practice Location

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