1649688391 NPI number — OUTREACH HEALTH SERVICES OF OKLAHOMA, LLC

Table of content: (NPI 1649688391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649688391 NPI number — OUTREACH HEALTH SERVICES OF OKLAHOMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTREACH HEALTH SERVICES OF OKLAHOMA, LLC
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:
OUTREACH HEALTH SERVICES
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:
1649688391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 RENNER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75080-1316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-692-7839
Provider Business Mailing Address Fax Number:
972-792-6739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1302B SW LEE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73501-5610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-355-1870
Provider Business Practice Location Address Fax Number:
580-355-1877
Provider Enumeration Date:
07/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE LEGAL MANAGER
Authorized Official Telephone Number:
512-692-7839

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HC8071 . This is a "OKLAHOMA STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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