Healthcare Provider Details

I. General information

NPI: 1598445165
Provider Name (Legal Business Name): LEVI JAPHETH POHOCSUCUT BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 1/4 MILES N ON HWY 281
ANADARKO OK
73005
US

IV. Provider business mailing address

PO BOX 729
ANADARKO OK
73005-0729
US

V. Phone/Fax

Practice location:
  • Phone: 405-247-2425
  • Fax: 405-247-2430
Mailing address:
  • Phone: 405-247-2425
  • Fax: 405-247-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: