1144777319 NPI number — NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144777319 NPI number — NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, 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:
Provider Other Organization Name Type Code:
6
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:
1144777319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HULBERT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74441-0751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-772-3390
Provider Business Mailing Address Fax Number:
918-772-2244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 N. OAK ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-444-2126
Provider Business Practice Location Address Fax Number:
918-458-2300
Provider Enumeration Date:
09/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENTHAL
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
918-772-3390

Provider Taxonomy Codes

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

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





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