Melvin J Vanboven, DO

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

1677 Issued in OK

Practice address

8803 S. 101St E. Ave
Suite 360
Tulsa, OK 74133

Phone

(918) 582-0001

Fax

(918) 582-0003

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: melvin.van.boven.1@14254.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/14254/brand/2/csg/1/fhir/r4
• Direct secure messaging: melvin.vanboven@direct.stjohnhealthsystem.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southwest Pathology, Inc

  • Clinical Medical Laboratory
  • Tulsa, OK
  • NPI 1356445969

  Anatomic Pathology & Clinical Pathology

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1003910522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26303",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731260303",
            "telephone_number": "918-582-0001",
            "fax_number": "918-582-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8803 S. 101ST E. AVE",
            "address_2": "SUITE 360",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74133",
            "telephone_number": "918-582-0001",
            "fax_number": "918-582-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANBOVEN",
        "first_name": "MELVIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OK",
            "license": "1677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL",
            "identifier": "223073900",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24563544102",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100258170B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Lynne Van Zandt, M.D.
• Nerine Van Zyl
• Ashley Marie Vanasse, MD
• Jamie Jon Vanbeber, LCSW
• Brandi Vanblarcum
• Corbyn L Vanbrunt DDS PC, DDS PC
• Maya Monique Vance
• Tate Camren Vance
• Carissa R. Vandagriff, CRNA
• Donna Kay Vandall, LCSW

• Anatomic Pathology & Clinical Pathology Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Anatomic Pathology & Clinical Pathology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.