Provider Demographics
NPI:1689738668
Name:ISMC NEUROLOGY SPECIALISTS
Entity Type:Organization
Organization Name:ISMC NEUROLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CE)
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:495-949-3011
Mailing Address - Street 1:4221 S WESTERN AVE
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3447
Mailing Address - Country:US
Mailing Address - Phone:405-644-5160
Mailing Address - Fax:405-644-5162
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 5000
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-5160
Practice Address - Fax:405-644-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTAX IDENTIFICATION