Organization Name: | THE BROADWAY CLINIC |
NPI Number: | 1760695274 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY BURNSTEIN (PRACTICE ADMINISTRATOR) |
Mailing Address: | 1801 N Broadway Ave Oklahoma City |
State: | OK US |
Postal Code: | 731033446 |
Phone Number: | 4055281936 |
Fax Number: | 4055218260 |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |