Provider Demographics
NPI:1609893403
Name:ACCESS ENDOCRINE, THYROID AND DIABETES CENTER
Entity Type:Organization
Organization Name:ACCESS ENDOCRINE, THYROID AND DIABETES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MODHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-728-7329
Mailing Address - Street 1:PO BOX 268988
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8988
Mailing Address - Country:US
Mailing Address - Phone:405-843-2066
Mailing Address - Fax:405-843-2077
Practice Address - Street 1:6001 NW 120TH CT
Practice Address - Street 2:SUITE 6
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1700
Practice Address - Country:US
Practice Address - Phone:405-728-7329
Practice Address - Fax:405-720-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK447721027005OtherBCBS
OK100131440AMedicaid
OK37D0471461OtherCLIA
OKD34734Medicare UPIN
OK37D0471461OtherCLIA