Provider Demographics
NPI:1760669188
Name:STEPHANIE FORBES DO PC INC
Entity Type:Organization
Organization Name:STEPHANIE FORBES DO PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-747-5565
Mailing Address - Street 1:4612 S HARVARD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2908
Mailing Address - Country:US
Mailing Address - Phone:918-747-5565
Mailing Address - Fax:918-747-5568
Practice Address - Street 1:4612 S HARVARD AVE
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2908
Practice Address - Country:US
Practice Address - Phone:918-747-5565
Practice Address - Fax:918-747-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200130140AMedicaid
OK444480454002OtherBCBS OF OKLAHOMA
OK200130140AMedicaid