Healthcare Provider Details

I. General information

NPI: 1821159922
Provider Name (Legal Business Name): PATHWAYS OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N 12TH AVE
DURANT OK
74701-4718
US

IV. Provider business mailing address

1161 N EL DORADO PL
TUCSON AZ
85715-4607
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-6363
  • Fax: 580-924-0379
Mailing address:
  • Phone: 520-570-1460
  • Fax: 520-745-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY POE
Title or Position: CONTRACT ADMINISTRATOR
Credential:
Phone: 520-570-1460