Provider Demographics
NPI:1548449374
Name:ROGER L KINNEY MD PC
Entity type:Organization
Organization Name:ROGER L KINNEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-248-5393
Mailing Address - Street 1:27 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-3901
Mailing Address - Country:US
Mailing Address - Phone:918-248-5393
Mailing Address - Fax:918-248-5399
Practice Address - Street 1:27 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-3901
Practice Address - Country:US
Practice Address - Phone:918-248-5393
Practice Address - Fax:918-248-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK443402928004OtherBLUE CROSS