Provider Demographics
NPI:1184891525
Name:STATE OF OKLAHOMA
Entity type:Organization
Organization Name:STATE OF OKLAHOMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GITANJALI
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-426-8650
Mailing Address - Street 1:123 ROBERT S KERR AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-6406
Mailing Address - Country:US
Mailing Address - Phone:405-426-8650
Mailing Address - Fax:405-900-7598
Practice Address - Street 1:123 ROBERT S KERR AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-6406
Practice Address - Country:US
Practice Address - Phone:405-426-8650
Practice Address - Fax:405-900-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100055420BMedicaid
OK100055420BMedicaid
OKOKB6116Medicare PIN