Provider Demographics
NPI:1790991925
Name:PATRICIA W HEFTON PROFESSIONAL CORP
Entity Type:Organization
Organization Name:PATRICIA W HEFTON PROFESSIONAL CORP
Other - Org Name:PATRICIA W. REID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFTON-REID
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:405-692-2118
Mailing Address - Street 1:PO BOX 19635
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73144-0635
Mailing Address - Country:US
Mailing Address - Phone:405-962-2118
Mailing Address - Fax:405-691-6499
Practice Address - Street 1:6870 AMBRIZ
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-9093
Practice Address - Country:US
Practice Address - Phone:405-692-2118
Practice Address - Fax:405-691-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0019966174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTAX ID