Provider Demographics
NPI:1699464339
Name:SLEEP SPECIALISTS OF NORTHERN OKLAHOMA PLLC
Entity type:Organization
Organization Name:SLEEP SPECIALISTS OF NORTHERN OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-366-1638
Mailing Address - Street 1:615 E OKLAHOMA AVE STE 204B
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5959
Mailing Address - Country:US
Mailing Address - Phone:580-366-1638
Mailing Address - Fax:
Practice Address - Street 1:615 E OKLAHOMA AVE STE 204B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701
Practice Address - Country:US
Practice Address - Phone:580-366-1638
Practice Address - Fax:580-405-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty