NPIMap

Organization Active NPI

Olive Branch Psychiatry

  • Child & Adolescent Psychiatry Physician
  • Oklahoma City, OK
National Provider Identifier
1528512183
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
OLIVE BRANCH PSYCHIATRY
Practice address
13821 Technology Dr Ste B
Oklahoma City, OK 73134-1046
Phone
(405) 451-3454
Fax
(405) 451-3454
NPI assigned
Aug 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
William Oliva, MDNPI 1356781199
Title
Chief Medical Officer
Phone
(405) 451-3454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

13821 Technology Dr Ste B
Oklahoma City, OK 73134-1046

Mailing address

13821 Technology Dr Ste B
Oklahoma City, OK 73134-1046
Phone (405) 451-3454

Other names 2

  • Oliva Branch Clinic Doing business as
  • Olive Branch Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161103000121 OK Part B Supplier - Clinic/Group Practice 0042598567 Receives reassigned benefits from 4 practitioners
Practice locations: Oklahoma City, OK

National Provider Directory

National Provider Directory

Locations

13821 Technology Dr
Ste B
Oklahoma City, OK 73134
Phone (405) 451-3454

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1528512183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13821 TECHNOLOGY DR STE B",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341046",
            "telephone_number": "405-451-3454",
            "fax_number": "405-543-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13821 TECHNOLOGY DR STE B",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341046",
            "telephone_number": "405-451-3454",
            "fax_number": "405-451-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-11",
        "last_updated": "2022-10-04",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "OLIVA",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "405-451-3454",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oliva Branch Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Olive Branch Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.