1871960195 NPI number — COORDINATED CARE HEALTH SOLUTIONS, LLC

Table of content: (NPI 1871960195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871960195 NPI number — COORDINATED CARE HEALTH SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COORDINATED CARE HEALTH SOLUTIONS, 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:
CCHS LABS
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:
1871960195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 N PORTLAND AVE
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-608-8039
Provider Business Mailing Address Fax Number:
405-463-0120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10120 BROADWAY EXT STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73114-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-605-0720
Provider Business Practice Location Address Fax Number:
405-463-0120
Provider Enumeration Date:
08/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HOGAN
Authorized Official First Name:
HUNTER
Authorized Official Middle Name:
JOE
Authorized Official Title or Position:
AM
Authorized Official Telephone Number:
405-418-2929

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1871960195 , 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: 367240401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200622830 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871960195 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26303 . This is a "COLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37D2093763 . This is a "CLIA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 212247709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026596800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871960195 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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