Provider Demographics
NPI:1659144384
Name:NR EDMOND LLC
Entity Type:Organization
Organization Name:NR EDMOND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:COIT
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:405-501-6261
Mailing Address - Street 1:3908 N PENIEL AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3402
Mailing Address - Country:US
Mailing Address - Phone:405-495-7391
Mailing Address - Fax:
Practice Address - Street 1:3520 S BOULEVARD STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5413
Practice Address - Country:US
Practice Address - Phone:405-495-7391
Practice Address - Fax:405-669-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty