Provider Demographics
NPI:1114179090
Name:OKLA REHAB PULMONARY SPECIALIST
Entity Type:Organization
Organization Name:OKLA REHAB PULMONARY SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-488-9992
Mailing Address - Street 1:6767 S YALE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 PLAZA SOUTH
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-488-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKLAHOMA REHAB SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK1843261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK374513Medicare Oscar/Certification