Provider Demographics
NPI:1164661120
Name:MICHAEL E SALRIN HEALTH SERVICE, INC
Entity Type:Organization
Organization Name:MICHAEL E SALRIN HEALTH SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SALRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-382-6097
Mailing Address - Street 1:11487 S 354
Mailing Address - Street 2:
Mailing Address - City:EARLSBORO
Mailing Address - State:OK
Mailing Address - Zip Code:74840-9011
Mailing Address - Country:US
Mailing Address - Phone:405-382-0697
Mailing Address - Fax:405-382-0421
Practice Address - Street 1:11487 S 354
Practice Address - Street 2:
Practice Address - City:EARLSBORO
Practice Address - State:OK
Practice Address - Zip Code:74840-9011
Practice Address - Country:US
Practice Address - Phone:405-382-0697
Practice Address - Fax:405-382-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKB91215Medicare UPIN