Provider Demographics
NPI:1134259658
Name:INTERNAL MEDICINE OF BARTLESVILLE PLLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF BARTLESVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-336-2273
Mailing Address - Street 1:1812 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6228
Mailing Address - Country:US
Mailing Address - Phone:918-335-2273
Mailing Address - Fax:918-335-1290
Practice Address - Street 1:1812 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6228
Practice Address - Country:US
Practice Address - Phone:918-335-2273
Practice Address - Fax:918-335-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200013160AMedicaid
OK200013160AMedicaid
OKG57429Medicare UPIN