Healthcare Provider Details

I. General information

NPI: 1083650600
Provider Name (Legal Business Name): MEDICAL CENTER OF SOUTHEAST OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W UNIVERSITY BLVD
DURANT OK
74701-3006
US

IV. Provider business mailing address

1800 W UNIVERSITY BLVD
DURANT OK
74701-3006
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-3080
  • Fax: 580-920-0119
Mailing address:
  • Phone: 580-924-3080
  • Fax: 580-920-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number274441
License Number StateOK

VIII. Authorized Official

Name: JOHN HARMS
Title or Position: PHCY DIR
Credential:
Phone: 580-924-3080