Provider Demographics
NPI:1598941338
Name:RAYMOND C. BOTHELL & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:RAYMOND C. BOTHELL & ASSOCIATES, INC.
Other - Org Name:ADVANCED HEARING SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:BOTHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC
Authorized Official - Phone:918-744-1390
Mailing Address - Street 1:4444 S HARVARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2634
Mailing Address - Country:US
Mailing Address - Phone:918-744-1390
Mailing Address - Fax:918-744-6613
Practice Address - Street 1:4444 S HARVARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2634
Practice Address - Country:US
Practice Address - Phone:918-744-1390
Practice Address - Fax:918-744-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherCURRENT FEIN