Provider Demographics
NPI:1770721169
Name:OKLAHOMA HEART HOSPITAL LLC
Entity type:Organization
Organization Name:OKLAHOMA HEART HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-608-3300
Mailing Address - Street 1:4050 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8382
Mailing Address - Country:US
Mailing Address - Phone:405-608-3300
Mailing Address - Fax:405-608-1550
Practice Address - Street 1:5520 N FRANCIS AVE
Practice Address - Street 2:IMAGING NORTH
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6040
Practice Address - Country:US
Practice Address - Phone:405-840-0088
Practice Address - Fax:405-608-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2354207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200009170AMedicaid
OK200009170AMedicaid