Provider Demographics
NPI:1518708635
Name:NR STILLWATER LLC
Entity type:Organization
Organization Name:NR STILLWATER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-953-7221
Mailing Address - Street 1:3705 NW 63RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1937
Mailing Address - Country:US
Mailing Address - Phone:405-953-7221
Mailing Address - Fax:
Practice Address - Street 1:1411 W 12TH AVE STE D
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5482
Practice Address - Country:US
Practice Address - Phone:405-724-6902
Practice Address - Fax:405-669-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty