Provider Demographics
NPI:1255382941
Name:RITA S WESTENHAVER D.O. FAMILY PRACTICE PC
Entity type:Organization
Organization Name:RITA S WESTENHAVER D.O. FAMILY PRACTICE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIN
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WESTENHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-314-2295
Mailing Address - Street 1:62420 E HIGHWAY 137
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-7474
Mailing Address - Country:US
Mailing Address - Phone:918-314-2295
Mailing Address - Fax:866-659-6935
Practice Address - Street 1:62420 E HIGHWAY 137
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7474
Practice Address - Country:US
Practice Address - Phone:918-314-2295
Practice Address - Fax:866-659-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2731208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
731438253-007OtherGROUP BCBS
OK100710600EMedicaid
OK243732001Medicare PIN
E45372Medicare UPIN