Healthcare Provider Details

I. General information

NPI: 1659600815
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 4 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W. BYPASS
DRUMRIGHT OK
74030
US

IV. Provider business mailing address

610 W BYPASS
DRUMRIGHT OK
74030-5957
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-5955
  • Fax: 918-382-4709
Mailing address:
  • Phone: 918-382-2300
  • Fax: 918-382-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2367
License Number StateOK

VIII. Authorized Official

Name: RYAN E CAPSHEW
Title or Position: CEO
Credential:
Phone: 918-382-2300