Healthcare Provider Details

I. General information

NPI: 1164725305
Provider Name (Legal Business Name): SOUTHEASTERN OKLAHOMA FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 E FOLEY ST
EUFAULA OK
74432-3019
US

IV. Provider business mailing address

PO BOX 1710
KINGSTON OK
73439-1710
US

V. Phone/Fax

Practice location:
  • Phone: 918-618-4766
  • Fax: 918-618-4786
Mailing address:
  • Phone: 580-745-9610
  • Fax: 580-745-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. VIRGINIA RAGAN
Title or Position: CEO
Credential:
Phone: 580-745-9610