Provider Demographics
NPI:1972771616
Name:CENTRAL FITT, INC
Entity Type:Organization
Organization Name:CENTRAL FITT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN,VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:405-503-2759
Mailing Address - Street 1:2010 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4019
Mailing Address - Country:US
Mailing Address - Phone:405-503-2759
Mailing Address - Fax:405-330-9921
Practice Address - Street 1:2010 S BROADWAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4019
Practice Address - Country:US
Practice Address - Phone:405-503-2759
Practice Address - Fax:405-330-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1530133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1669651188OtherNPI--INDIVIDUAL