Provider Demographics
NPI:1700854106
Name:GI OF NORMAN, LLC
Entity Type:Organization
Organization Name:GI OF NORMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEFFREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-360-2777
Mailing Address - Street 1:1125 N PORTER AVE
Mailing Address - Street 2:STE. 301
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6443
Mailing Address - Country:US
Mailing Address - Phone:405-360-2777
Mailing Address - Fax:405-360-2780
Practice Address - Street 1:1125 N PORTER AVE
Practice Address - Street 2:STE. 301
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6443
Practice Address - Country:US
Practice Address - Phone:405-360-2777
Practice Address - Fax:405-360-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200069740AMedicaid
400522548Medicare ID - Type Unspecified