Healthcare Provider Details

I. General information

NPI: 1659566263
Provider Name (Legal Business Name): CHOUTEAU-MAZIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MCCRAKEN
CHOUTEAU OK
74337-0969
US

IV. Provider business mailing address

PO BOX 969
CHOUTEAU OK
74337-0969
US

V. Phone/Fax

Practice location:
  • Phone: 918-476-8386
  • Fax:
Mailing address:
  • Phone: 918-476-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. TOM TURNER
Title or Position: SUPERINTENDENT
Credential:
Phone: 918-476-8386