Provider Demographics
NPI:1871048249
Name:JIMMY KEITH OGDEN DC PC
Entity type:Organization
Organization Name:JIMMY KEITH OGDEN DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DC
Authorized Official - Phone:918-686-6932
Mailing Address - Street 1:3711 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4930
Mailing Address - Country:US
Mailing Address - Phone:918-686-6932
Mailing Address - Fax:539-313-9092
Practice Address - Street 1:3711 CHANDLER RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4930
Practice Address - Country:US
Practice Address - Phone:918-686-6932
Practice Address - Fax:539-313-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA104003Medicare PIN
OKU66409Medicare UPIN