Provider Demographics
NPI:1629190376
Name:JANITA M. ARDIS, M.D. INC.
Entity Type:Organization
Organization Name:JANITA M. ARDIS, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-943-8924
Mailing Address - Street 1:3817 NW EXPRESSWAY ST STE 710
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1465
Mailing Address - Country:US
Mailing Address - Phone:405-943-8924
Mailing Address - Fax:405-943-8967
Practice Address - Street 1:3817 NW EXPRESSWAY ST STE 710
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1465
Practice Address - Country:US
Practice Address - Phone:405-943-8924
Practice Address - Fax:405-943-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC94643Medicare UPIN