Provider Demographics
NPI:1093257941
Name:OKLAHOMA HEART CLINICS
Entity Type:Organization
Organization Name:OKLAHOMA HEART CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FAZAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-541-2862
Mailing Address - Street 1:5200 E I-204 SERVICE ROAD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135
Mailing Address - Country:US
Mailing Address - Phone:405-644-5428
Mailing Address - Fax:
Practice Address - Street 1:4221 S WESTERN AVE STE 5020
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3445
Practice Address - Country:US
Practice Address - Phone:405-644-5428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAZAL AKBAR ALI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24-129207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK337876Medicare PIN