Provider Demographics
NPI:1225746076
Name:VICKREY, CHASE
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:VICKREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5135
Mailing Address - Country:US
Mailing Address - Phone:405-990-0816
Mailing Address - Fax:
Practice Address - Street 1:201 N BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5135
Practice Address - Country:US
Practice Address - Phone:405-990-0816
Practice Address - Fax:405-735-6116
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator