Healthcare Provider Details

I. General information

NPI: 1588946578
Provider Name (Legal Business Name): REDLANDS COMMUNITY COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S COUNTRY CLUB RD
EL RENO OK
73036-5304
US

IV. Provider business mailing address

PO BOX 819020
DALLAS TX
75381-9020
US

V. Phone/Fax

Practice location:
  • Phone: 866-415-6367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELI ZUCKSWORTH
Title or Position: HEAD TRAINER
Credential:
Phone: 405-422-6279