Provider Demographics
NPI:1326122706
Name:HERITAGE PARK MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HERITAGE PARK MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:DANKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-737-1242
Mailing Address - Street 1:PO BOX 25016
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-0016
Mailing Address - Country:US
Mailing Address - Phone:405-737-6871
Mailing Address - Fax:405-737-7700
Practice Address - Street 1:6908 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2128
Practice Address - Country:US
Practice Address - Phone:405-737-6871
Practice Address - Fax:405-737-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200102570AMedicaid
OK400522292Medicare PIN
OK200102570AMedicaid