Healthcare Provider Details

I. General information

NPI: 1770497125
Provider Name (Legal Business Name): SOUTHERN PLAINS MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 ARLINGTON ST
ADA OK
74820-2639
US

IV. Provider business mailing address

2222 W IOWA AVE
CHICKASHA OK
73018-2738
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-8111
  • Fax:
Mailing address:
  • Phone: 405-224-8111
  • Fax: 405-594-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: HARESHKUMAR BOGHARA
Title or Position: OWNER
Credential:
Phone: 469-985-3746