Healthcare Provider Details

I. General information

NPI: 1639636657
Provider Name (Legal Business Name): EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 WEST MAIN STREET
HENRYETTA OK
74437
US

IV. Provider business mailing address

P.O. BOX 236
WETUMKA OK
74883
US

V. Phone/Fax

Practice location:
  • Phone: 918-652-9615
  • Fax: 918-652-7612
Mailing address:
  • Phone: 405-452-3151
  • Fax: 405-452-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DONNA DYER
Title or Position: CEO
Credential: MSHR
Phone: 405-452-3151