Provider Demographics
NPI:1477721975
Name:PULMONOLOGY ASSOCIATES OF ENID
Entity Type:Organization
Organization Name:PULMONOLOGY ASSOCIATES OF ENID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN REGIONAL PRACT MGMT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-548-1367
Mailing Address - Street 1:DEPT 960333
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0333
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1583
Practice Address - Street 1:401 E OKLAHOMA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5800
Practice Address - Country:US
Practice Address - Phone:580-234-5155
Practice Address - Fax:580-234-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200200250AMedicaid
OKOKB5193Medicare PIN
OKDN9971Medicare PIN