Healthcare Provider Details

I. General information

NPI: 1407145121
Provider Name (Legal Business Name): NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E MAIN ST
HULBERT OK
74441-8901
US

IV. Provider business mailing address

131 E MAIN ST
HULBERT OK
74441-8901
US

V. Phone/Fax

Practice location:
  • Phone: 918-772-2727
  • Fax: 918-772-6131
Mailing address:
  • Phone: 918-772-2727
  • Fax: 918-772-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number36-5888
License Number StateOK

VIII. Authorized Official

Name: SCOTT ROSENTHAL
Title or Position: CEO
Credential:
Phone: 918-772-3390