Provider Demographics
NPI:1043433501
Name:OKLAHOMA NEUROSCIENCE AND ADDICTIONOLOGY
Entity type:Organization
Organization Name:OKLAHOMA NEUROSCIENCE AND ADDICTIONOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:580-762-4103
Mailing Address - Street 1:900 E HARTFORD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2011
Mailing Address - Country:US
Mailing Address - Phone:580-762-4103
Mailing Address - Fax:580-762-4103
Practice Address - Street 1:900 E HARTFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2011
Practice Address - Country:US
Practice Address - Phone:580-762-4103
Practice Address - Fax:580-762-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2141261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty