Healthcare Provider Details

I. General information

NPI: 1114302692
Provider Name (Legal Business Name): SOUTHEASTERN PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST SUITE B
MCALESTER OK
74501-5369
US

IV. Provider business mailing address

100 S MAIN ST SUITE B
MCALESTER OK
74501-5369
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-3700
  • Fax:
Mailing address:
  • Phone: 918-423-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR0058049
License Number StateOK

VIII. Authorized Official

Name: DR. RICHARD BOWDEN
Title or Position: OWNER
Credential: M.D,
Phone: 918-423-3700