Provider Demographics
NPI:1598480220
Name:NR SOUTHWEST OKC LLC
Entity Type:Organization
Organization Name:NR SOUTHWEST OKC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-495-7391
Mailing Address - Street 1:3908 N PENIEL AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3402
Mailing Address - Country:US
Mailing Address - Phone:405-495-7391
Mailing Address - Fax:
Practice Address - Street 1:9821 S MAY AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7042
Practice Address - Country:US
Practice Address - Phone:405-495-7391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty