Provider Demographics
NPI:1548398274
Name:NORMAN REGIONAL PROVIDERS PRIMARY CARE
Entity Type:Organization
Organization Name:NORMAN REGIONAL PROVIDERS PRIMARY CARE
Other - Org Name:MOORE MEDICAL CENTER PHYSICIAN ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPLITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-515-1050
Mailing Address - Street 1:901 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6482
Mailing Address - Country:US
Mailing Address - Phone:405-307-1000
Mailing Address - Fax:
Practice Address - Street 1:500 E ROBINSON ST STE 2400
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6684
Practice Address - Country:US
Practice Address - Phone:405-515-0380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100138480DMedicaid
OK100138480DMedicaid