Basic Information
Provider Information | |||||||||
NPI: | 1962953547 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SAINT FRANCIS HOSPITAL VINITA, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6600 S YALE AVE | ||||||||
Address2: | SUITE 500 | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741363347 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9185028013 | ||||||||
FaxNumber: | 9185028002 | ||||||||
Practice Location | |||||||||
Address1: | 116 S WILSON ST | ||||||||
Address2: |   | ||||||||
City: | VINITA | ||||||||
State: | OK | ||||||||
PostalCode: | 743013730 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9182560282 | ||||||||
FaxNumber: | 9182567343 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/19/2016 | ||||||||
LastUpdateDate: | 10/19/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | EDWARDS | ||||||||
AuthorizedOfficialFirstName: | RENEE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR-PATIENT FINANCIAL SERVICES | ||||||||
AuthorizedOfficialTelephone: | 9185028010 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SAINT FRANCIS HOSPITAL VINITA, INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.