Healthcare Provider Details

I. General information

NPI: 1699025973
Provider Name (Legal Business Name): GREAT SALT PLAINS HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 FRONT STREET
MEDFORD OK
73759-1209
US

IV. Provider business mailing address

405 S OKLAHOMA AVE
CHEROKEE OK
73728-2545
US

V. Phone/Fax

Practice location:
  • Phone: 580-395-3200
  • Fax: 580-596-2805
Mailing address:
  • Phone: 580-596-2800
  • Fax: 580-596-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TIM STARKEY
Title or Position: CEO
Credential:
Phone: 580-596-2800