Provider Demographics
NPI:1174788251
Name:NORMAN NEUROSCIENCE PHYSICIANS
Entity type:Organization
Organization Name:NORMAN NEUROSCIENCE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP, COO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:L
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-307-1000
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-5700
Mailing Address - Fax:405-307-5704
Practice Address - Street 1:724 24TH AVE NW
Practice Address - Street 2:STE 220
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6218
Practice Address - Country:US
Practice Address - Phone:405-307-5700
Practice Address - Fax:405-307-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200210450AMedicaid
OK200210450AMedicaid