Provider Demographics
NPI:1699802389
Name:ARNETTE, JEFFREY M (CPO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:ARNETTE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452007
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-2007
Mailing Address - Country:US
Mailing Address - Phone:918-786-7701
Mailing Address - Fax:918-786-7708
Practice Address - Street 1:311 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5954
Practice Address - Country:US
Practice Address - Phone:918-681-2346
Practice Address - Fax:918-681-4749
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1189690001Medicare NSC