Provider Demographics
NPI:1952533648
Name:R. MICHAEL EIMEN, D.O.
Entity Type:Organization
Organization Name:R. MICHAEL EIMEN, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:EIMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-865-5000
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-0323
Mailing Address - Country:US
Mailing Address - Phone:918-865-5000
Mailing Address - Fax:918-865-5050
Practice Address - Street 1:500 CIMARRON DR
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-9504
Practice Address - Country:US
Practice Address - Phone:918-865-5000
Practice Address - Fax:918-865-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2010-07-21
Deactivation Date:2010-03-17
Deactivation Code:
Reactivation Date:2010-07-21
Provider Licenses
StateLicense IDTaxonomies
OK2520207Q00000X
OKPA1777363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty