Provider Demographics
NPI:1962457861
Name:NORMAN SPECIALTY HOSPITAL LLC
Entity Type:Organization
Organization Name:NORMAN SPECIALTY HOSPITAL LLC
Other - Org Name:NORMAN SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT-REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5541
Mailing Address - Street 1:440 BENMAR DRIVE
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3105
Mailing Address - Country:US
Mailing Address - Phone:281-272-9027
Mailing Address - Fax:281-272-9712
Practice Address - Street 1:1210 W ROBINSON ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7401
Practice Address - Country:US
Practice Address - Phone:405-321-8824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RP1001X
OK2364282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282E00000XHospitalsLong Term Care Hospital
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200075820AMedicaid
OK200075820AMedicaid