Healthcare Provider Details

I. General information

NPI: 1932749348
Provider Name (Legal Business Name): SOUTHERN OKLAHOMA TREATMENT SERICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARLINGTON ST STE G
ADA OK
74820-4072
US

IV. Provider business mailing address

PO BOX 1710
KINGSTON OK
73439-1710
US

V. Phone/Fax

Practice location:
  • Phone: 580-235-0274
  • Fax:
Mailing address:
  • Phone: 580-795-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA RAGAN
Title or Position: VP ADMIN
Credential:
Phone: 580-795-6377