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NPI Code Detail

MEDICARE: SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC

MEDICARE: SOUTHEASTERN OKLAHOMA FAMILY 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376884312
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC
Provider Business Mailing Address
First Line : PO BOX 1710
Second Line :
City : KINGSTON
State : OK
Zip : 73439-1710
Country : US
Telephone Number : 580-564-7374
Fax Number : 580-745-9650
Provider Business Practice Location Address
First Line : 113653 OLD HIGHWAY 69
Second Line :
City : CHECOTAH
State : OK
Zip : 74426-8802
Country : US
Telephone Number : 918-490-2073
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : BRE'YON JAMES
Credential :
Telephone Number : 918-490-3800
Provider Enumeration Date : 03/14/2013
Last Update Date : 11/21/2023

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Directions to “SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC ” Practice Location

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