Provider Demographics
NPI:1891819819
Name:J.M.DILLING,JR.,M.D.JR.,INC
Entity type:Organization
Organization Name:J.M.DILLING,JR.,M.D.JR.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-233-2200
Mailing Address - Street 1:3201 N VAN BUREN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1812
Mailing Address - Country:US
Mailing Address - Phone:580-233-2200
Mailing Address - Fax:580-234-2915
Practice Address - Street 1:3201 N VAN BUREN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1812
Practice Address - Country:US
Practice Address - Phone:580-233-2200
Practice Address - Fax:580-234-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE10807Medicare UPIN