Provider Demographics
NPI:1376067793
Name:WILLIAM PARKER HIGHLAND PARK
Entity Type:Organization
Organization Name:WILLIAM PARKER HIGHLAND PARK
Other - Org Name:PARADIGM HORMONES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSELLATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-703-3614
Mailing Address - Street 1:1301 S I 35 SERVICE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3187
Mailing Address - Country:US
Mailing Address - Phone:405-703-3614
Mailing Address - Fax:
Practice Address - Street 1:4442 LOVERS LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6923
Practice Address - Country:US
Practice Address - Phone:405-703-3614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARADIGM HORMONES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center