1538155163 NPI number — MORTON COMPREHENSIVE HEALTH SERVICES, INC.

Table of content: (NPI 1538155163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538155163 NPI number — MORTON COMPREHENSIVE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORTON COMPREHENSIVE HEALTH SERVICES, 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:
NOWATA FAMILY HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1538155163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1334 N LANSING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74106-5907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-587-2171
Provider Business Mailing Address Fax Number:
918-273-9946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 S LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOWATA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74048-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-273-9911
Provider Business Practice Location Address Fax Number:
918-273-9946
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
SAUNYA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
918-295-6107

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1538155163 . This is a "NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100768880J , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: WCDPG . This is a "MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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