Healthcare Provider Details

I. General information

NPI: 1255648580
Provider Name (Legal Business Name): SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113653 OLD HIGHWAY 69
CHECOTAH OK
74426-8802
US

IV. Provider business mailing address

PO BOX 1709
KINGSTON OK
73439-1709
US

V. Phone/Fax

Practice location:
  • Phone: 580-565-4235
  • Fax:
Mailing address:
  • Phone: 580-564-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRE'YON JAMES
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 918-490-1352