Provider Demographics
NPI:1821059015
Name:NORTH CENTRAL OKLAHOMA
Entity Type:Organization
Organization Name:NORTH CENTRAL OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:BERRY
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-762-6676
Mailing Address - Street 1:121 PATTON DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2030
Mailing Address - Country:US
Mailing Address - Phone:580-762-6676
Mailing Address - Fax:580-762-0094
Practice Address - Street 1:121 PATTON DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2030
Practice Address - Country:US
Practice Address - Phone:580-762-6676
Practice Address - Fax:580-762-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071520AMedicaid
=========001OtherBCBS
OK200071520AMedicaid