Provider Demographics
NPI:1891917027
Name:ENID INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:ENID INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT RURAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:WEINMEISTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:580-548-1367
Mailing Address - Street 1:PO BOX 960242
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0242
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1537
Practice Address - Street 1:330 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5714
Practice Address - Country:US
Practice Address - Phone:580-233-4353
Practice Address - Fax:580-233-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100210100AMedicaid
OK200051450AMedicaid
OK200112770AMedicaid
KS200317740BMedicaid
OK=========-001OtherBCBS OF OKLAHOMA
OK249722101Medicare PIN
OK=========-001OtherBCBS OF OKLAHOMA
OK200112770AMedicaid
KS200317740BMedicaid