MEDICARE: OKLAHOMA BLOOD INSTITUTE

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	331L00000X	Blood Bank	37D0470358	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37-HL01	OTHER	OK	CMS PTAN

General Provider Information

NPI Number	:	1720357841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA BLOOD INSTITUTE

Provider Business Mailing Address
First Line	:	1001 N LINCOLN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3251
Country	:	US
Telephone Number	:	405-297-5511
Fax Number	:	405-228-9911

Provider Business Practice Location Address
First Line	:	1001 N LINCOLN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3251
Country	:	US
Telephone Number	:	405-297-5511
Fax Number	:	405-228-9911

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	RANDALL G STARK
Credential	:
Telephone Number	:	405-297-5501

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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Directions to “OKLAHOMA BLOOD INSTITUTE ” Practice Location

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