Healthcare Provider Details

I. General information

NPI: 1962509802
Provider Name (Legal Business Name): CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 ARLINGTON ST
ADA OK
74820-4038
US

IV. Provider business mailing address

1131 ARLINGTON ST
ADA OK
74820-4038
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-5720
  • Fax: 580-332-5724
Mailing address:
  • Phone: 580-332-5720
  • Fax: 580-332-5724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number23-6131
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRENDA WARE
Title or Position: CEO
Credential:
Phone: 580-436-5111