1790866481 NPI number — SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.

Table of content: (NPI 1790866481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790866481 NPI number — SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHWEST ENTERPRISES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790866481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTUS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73522-1088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-482-5040
Provider Business Mailing Address Fax Number:
580-482-5433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2208 ENTERPRISE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTUS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73521-5843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-477-0701
Provider Business Practice Location Address Fax Number:
580-477-0702
Provider Enumeration Date:
10/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
580-482-5040

Provider Taxonomy Codes

  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)