Basic Information
| Provider Information | |||||||||
| NPI: | 1952533648 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | R. MICHAEL EIMEN, D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 323 | ||||||||
| Address2: | |||||||||
| City: | MANNFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740440323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188655000 | ||||||||
| FaxNumber: | 9188655050 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 CIMARRON DR | ||||||||
| Address2: | |||||||||
| City: | MANNFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740449504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188655000 | ||||||||
| FaxNumber: | 9188655050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/17/2010 | ||||||||
| NPIReactivationDate: | 07/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | EIMEN | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9188655000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA1777 | OK | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207Q00000X | 2520 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.