Provider Demographics
NPI:1144491853
Name:RENAL AND HYPERTENSION INSTITUTE OF NORTHEAST OKLAHOMA
Entity type:Organization
Organization Name:RENAL AND HYPERTENSION INSTITUTE OF NORTHEAST OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF MANAGERS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-453-2263
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1008
Mailing Address - Country:US
Mailing Address - Phone:918-453-2121
Mailing Address - Fax:
Practice Address - Street 1:1607 S MUSKOGEE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5440
Practice Address - Country:US
Practice Address - Phone:918-453-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment