Basic Information
| Provider Information | |||||||||
| NPI: | 1356543516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNDBYE | ||||||||
| FirstName: | WADE | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | MCBRIDE CLINIC, INC. | ||||||||
| Address2: | 815 NW 12TH | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052309575 | ||||||||
| FaxNumber: | 4052282569 | ||||||||
| Practice Location | |||||||||
| Address1: | MCBRIDE CLINIC, INC. | ||||||||
| Address2: | 815 NW 12TH | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052309575 | ||||||||
| FaxNumber: | 4052282569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | 132 | OK | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.