Provider Demographics
NPI:1235302555
Name:S BAR D, INC.
Entity Type:Organization
Organization Name:S BAR D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-825-3107
Mailing Address - Street 1:109 N FAIRLAND ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4225
Mailing Address - Country:US
Mailing Address - Phone:918-825-3107
Mailing Address - Fax:918-825-3128
Practice Address - Street 1:109 N FAIRLAND ST STE 109
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4225
Practice Address - Country:US
Practice Address - Phone:918-825-3107
Practice Address - Fax:918-825-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104854876OtherNPI
446604203006OtherBLUECROSS BLUE SHIELD
1104854876OtherNPI
446604203KMedicare PIN