Provider Demographics
NPI:1104900554
Name:DONEY MEDICAL, INC.
Entity type:Organization
Organization Name:DONEY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-542-8477
Mailing Address - Street 1:310 2ND AVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6702
Mailing Address - Country:US
Mailing Address - Phone:918-542-8477
Mailing Address - Fax:918-542-6422
Practice Address - Street 1:310 2ND AVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6702
Practice Address - Country:US
Practice Address - Phone:918-542-8477
Practice Address - Fax:918-542-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11653207Q00000X, 207V00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100209450AMedicaid
OK100735640AMedicaid
OK100209450AMedicaid
OK538448422Medicare ID - Type UnspecifiedDR. DONEY'S INDIVIDUAL #
OK100735640AMedicaid
OK1104900554Medicare Oscar/Certification