Provider Demographics
NPI:1720357841
Name:OKLAHOMA BLOOD INSTITUTE
Entity Type:Organization
Organization Name:OKLAHOMA BLOOD INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:G
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-297-5501
Mailing Address - Street 1:1001 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3251
Mailing Address - Country:US
Mailing Address - Phone:405-297-5511
Mailing Address - Fax:405-228-9911
Practice Address - Street 1:1001 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3251
Practice Address - Country:US
Practice Address - Phone:405-297-5511
Practice Address - Fax:405-228-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37D0470358331L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes331L00000XSuppliersBlood Bank
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-HL01OtherCMS PTAN