NPIMap

Organization Active NPI

Associated Dermatology and Hair Center

  • Dermatology Physician
  • Tulsa, OK
National Provider Identifier
1487804258
Registry record updated Sep 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
1497 Issued in OK
Legal business name
ASSOCIATED DERMATOLOGY AND HAIR CENTER
Practice address
1844 E 15TH St
Tulsa, OK 74104-4611
Phone
(918) 749-7177
NPI assigned
Sep 29, 2008
Last updated
Sep 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2008

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

Authorized official

Name
Earl Udo Bachenberg, D.O.NPI 1497713671
Title
Physician/Owner
Phone
(918) 749-7177

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 1497 OK Primary

Addresses

Primary practice location

1844 E 15TH St
Tulsa, OK 74104-4611

Mailing address

1844 E 15TH St
Tulsa, OK 74104-4611
Phone (918) 749-7177

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222646400000",
    "number": "1487804258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1844 E 15TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044611",
            "telephone_number": "918-749-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1844 E 15TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044611",
            "telephone_number": "918-749-7177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED DERMATOLOGY AND HAIR CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-29",
        "last_updated": "2008-09-29",
        "status": "A",
        "authorized_official_last_name": "BACHENBERG",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "UDO",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "918-749-7177",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "OK",
            "license": "1497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2008; 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.