Provider Demographics
NPI:1477954097
Name:RICHARD ZIELINSKI, PLLC
Entity type:Organization
Organization Name:RICHARD ZIELINSKI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BYTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-222-4786
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73023-0614
Mailing Address - Country:US
Mailing Address - Phone:405-222-4786
Mailing Address - Fax:405-222-1615
Practice Address - Street 1:117 S 7TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-3301
Practice Address - Country:US
Practice Address - Phone:405-222-4786
Practice Address - Fax:405-222-1615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD, ZIELINSKI, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-15
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK187952084P0800X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100230910AMedicaid