1457983595 NPI number — COMMUNITY HEALTH CONNECTION INC

Table of content: (NPI 1457983595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457983595 NPI number — COMMUNITY HEALTH CONNECTION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CONNECTION 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:
1457983595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2321 E 3RD ST
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:
74104-1831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-710-4460
Provider Business Mailing Address Fax Number:
918-710-4461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12020 E 31ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74146-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-710-4460
Provider Business Practice Location Address Fax Number:
918-710-4461
Provider Enumeration Date:
02/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
FINANCE
Authorized Official Telephone Number:
918-622-0641

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200082520F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com