Provider Demographics
NPI:1972790475
Name:G E EMDE, MD
Entity Type:Organization
Organization Name:G E EMDE, MD
Other - Org Name:G E EMDE, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HATTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-372-4646
Mailing Address - Street 1:821 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4226
Mailing Address - Country:US
Mailing Address - Phone:405-372-4646
Mailing Address - Fax:
Practice Address - Street 1:821 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4226
Practice Address - Country:US
Practice Address - Phone:405-372-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100251880AMedicaid
OK100251880AMedicaid