Provider Demographics
NPI:1306205026
Name:NAZALA HEALTHCARE INC PC
Entity Type:Organization
Organization Name:NAZALA HEALTHCARE INC PC
Other - Org Name:FAITH FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-470-6900
Mailing Address - Street 1:7221 W HEFNER RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4505
Mailing Address - Country:US
Mailing Address - Phone:405-470-6900
Mailing Address - Fax:405-470-6901
Practice Address - Street 1:7221 W HEFNER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4505
Practice Address - Country:US
Practice Address - Phone:405-470-6900
Practice Address - Fax:405-470-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17880208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100039090BMedicaid
OK18943OtherOBNDD
OK100039090BMedicaid