Basic Information
| Provider Information | |||||||||
| NPI: | 1619943511 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORMAN REGIONAL HOSPITAL EMSSTAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 268961 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731268961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053071000 | ||||||||
| FaxNumber: | 4053071304 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 N PORTER AVE | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053071000 | ||||||||
| FaxNumber: | 4053071304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | MEEGAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4053071050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | EMS381 | OK | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 100819460A | 05 | OK | MEDICAID |