Healthcare Provider Details

I. General information

NPI: 1760933634
Provider Name (Legal Business Name): MCO HEALTH PLANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 12TH AVE NW SUITE B
ARDMORE OK
73401-1196
US

IV. Provider business mailing address

1908 12TH AVE NW SUITE B
ARDMORE OK
73401-1196
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-8805
  • Fax: 580-223-8885
Mailing address:
  • Phone: 580-223-8805
  • Fax: 580-223-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. MICHAEL D HARDIMON
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA, BSN, RN
Phone: 828-989-6300