Provider Demographics
NPI:1386062909
Name:OKLAHOMA CITY NATURAL HORMONE REPLACEMENT CENTER LLC
Entity type:Organization
Organization Name:OKLAHOMA CITY NATURAL HORMONE REPLACEMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYICE
Authorized Official - Middle Name:BERT
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-942-5593
Mailing Address - Street 1:3617 NW 58TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4487
Mailing Address - Country:US
Mailing Address - Phone:405-942-5593
Mailing Address - Fax:405-942-5794
Practice Address - Street 1:3617 NW 58TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4487
Practice Address - Country:US
Practice Address - Phone:405-942-5593
Practice Address - Fax:405-942-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10054207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty