Provider Demographics
NPI:1760583595
Name:OKLAHOMA MEDICAL RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:OKLAHOMA MEDICAL RESEARCH FOUNDATION
Other - Org Name:CLINICAL IMMUNOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-271-7410
Mailing Address - Street 1:825 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-271-7395
Mailing Address - Fax:405-271-4119
Practice Address - Street 1:825 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5005
Practice Address - Country:US
Practice Address - Phone:405-271-7395
Practice Address - Fax:405-271-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QI0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK296266059001OtherBCBS
OK37D0713186Medicare PIN