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NPI Code Detail

MEDICARE: SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.

MEDICARE: SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1093353492
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Provider Business Mailing Address
First Line : PO BOX 48
Second Line :
City : MEAD
State : OK
Zip : 73449-0048
Country : US
Telephone Number : 580-564-7374
Fax Number :
Provider Business Practice Location Address
First Line : 113653 OLD HIGHWAY 69
Second Line :
City : CHECOTAH
State : OK
Zip : 74426-8802
Country : US
Telephone Number : 918-689-7416
Fax Number :
Authorized Official
Title or Position : ADMIN
Name : VIRGINIA RAGAN
Credential :
Telephone Number : 580-564-7374
Provider Enumeration Date : 12/16/2019
Last Update Date : 12/16/2019

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Directions to “SOUTHERN OKLAHOMA TREATMENT SERVICES, INC. ” Practice Location

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