Provider Demographics
NPI:1619036167
Name:ENID MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ENID MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ZANE
Authorized Official - Last Name:RICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-237-0322
Mailing Address - Street 1:721 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3880
Mailing Address - Country:US
Mailing Address - Phone:580-237-0322
Mailing Address - Fax:580-233-0402
Practice Address - Street 1:721 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3880
Practice Address - Country:US
Practice Address - Phone:580-237-0322
Practice Address - Fax:580-233-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP8467OtherRAILROAD MEDICARE ID
=========001OtherBLUE CROSS ID