Provider Demographics
NPI:1013001270
Name:MERCY HOSPITAL OKLAHOMA CITY, INC.
Entity Type:Organization
Organization Name:MERCY HOSPITAL OKLAHOMA CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VITIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-752-3724
Mailing Address - Street 1:4300 W MEMORIAL RD
Mailing Address - Street 2:ATTN: JON VITIELLO
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8304
Mailing Address - Country:US
Mailing Address - Phone:405-752-3724
Mailing Address - Fax:
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-752-3031
Practice Address - Fax:405-752-3061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL OKLAHOMA CITY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522343Medicare PIN