Healthcare Provider Details

I. General information

NPI: 1881876738
Provider Name (Legal Business Name): GREAT SALT PLAINS HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S. OKLAHOMA AVE
CHEROKEE OK
73728
US

IV. Provider business mailing address

405 S. OKLAHOMA AVE
CHEROKEE OK
73728
US

V. Phone/Fax

Practice location:
  • Phone: 580-596-2800
  • Fax: 580-596-2800
Mailing address:
  • Phone: 580-596-2800
  • Fax: 580-596-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIM STARKEY
Title or Position: CEO
Credential:
Phone: 580-596-2800