Provider Demographics
NPI:1922861004
Name:NR SHAWNEE, LLC
Entity Type:Organization
Organization Name:NR SHAWNEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:COIT
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-501-6261
Mailing Address - Street 1:3705 NW 63RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1937
Mailing Address - Country:US
Mailing Address - Phone:405-551-8103
Mailing Address - Fax:405-669-3517
Practice Address - Street 1:3700 N KICKAPOO AVE STE 116
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-0007
Practice Address - Country:US
Practice Address - Phone:405-551-8103
Practice Address - Fax:405-669-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty