Provider Demographics
NPI:1003082132
Name:NEIGHBORHOOD SERVICES ORGANIZATION INC
Entity Type:Organization
Organization Name:NEIGHBORHOOD SERVICES ORGANIZATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NINNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-236-0413
Mailing Address - Street 1:431 SW 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-5613
Mailing Address - Country:US
Mailing Address - Phone:405-236-0413
Mailing Address - Fax:405-236-1871
Practice Address - Street 1:431 SW 11TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-5613
Practice Address - Country:US
Practice Address - Phone:405-236-0413
Practice Address - Fax:405-236-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23021223G0001X
OK44801223G0001X
OK30651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty