Provider Demographics
NPI:1619174216
Name:HEART CLINIC OF CENTRAL OKLAHOMA, PC
Entity Type:Organization
Organization Name:HEART CLINIC OF CENTRAL OKLAHOMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DILAWER
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-321-0199
Mailing Address - Street 1:500 E ROBINSON ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6697
Mailing Address - Country:US
Mailing Address - Phone:405-321-0199
Mailing Address - Fax:405-321-8305
Practice Address - Street 1:500 E ROBINSON ST
Practice Address - Street 2:SUITE 900
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6697
Practice Address - Country:US
Practice Address - Phone:405-321-0199
Practice Address - Fax:405-321-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522046Medicare PIN