Healthcare Provider Details

I. General information

NPI: 1982785630
Provider Name (Legal Business Name): KIAMICHI OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NORTH 16TH
HUGO OK
74743-0669
US

IV. Provider business mailing address

PO BOX 669 405 NORTH 16TH
HUGO OK
74743-0669
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-7548
  • Fax: 580-326-7540
Mailing address:
  • Phone: 580-326-7548
  • Fax: 580-326-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. WILLIAM SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-326-7548