Provider Demographics
NPI:1295914083
Name:HARVEY L BABER
Entity type:Organization
Organization Name:HARVEY L BABER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-248-5393
Mailing Address - Street 1:27 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-3901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-3901
Practice Address - Country:US
Practice Address - Phone:918-248-5393
Practice Address - Fax:918-248-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK448408112001OtherBLUE CROSS