Healthcare Provider Details

I. General information

NPI: 1356788954
Provider Name (Legal Business Name): OKLAHOMA OTOLARYNGOLOGY HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 S BOULEVARD STE 160
EDMOND OK
73013-5780
US

IV. Provider business mailing address

PO BOX 960472
OKLAHOMA CITY OK
73196-0472
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-1810
  • Fax: 405-562-1816
Mailing address:
  • Phone: 405-755-6651
  • Fax: 405-755-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA L FOUTCH
Title or Position: PRACTICE ADMINISTRATION
Credential:
Phone: 405-755-6651