Provider Demographics
NPI:1972646503
Name:FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA
Entity Type:Organization
Organization Name:FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BEHAVIORAL HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-359-2481
Mailing Address - Street 1:PO BOX 20553
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0553
Mailing Address - Country:US
Mailing Address - Phone:405-359-2481
Mailing Address - Fax:405-359-2487
Practice Address - Street 1:1800 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3023
Practice Address - Country:US
Practice Address - Phone:405-359-2481
Practice Address - Fax:405-359-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK854103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty