Healthcare Provider Details

I. General information

NPI: 1568976991
Provider Name (Legal Business Name): ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTH 32ND STREET
MUSKOGEE OK
74401-2104
US

IV. Provider business mailing address

PO BOX 334
PORTER OK
74454-0334
US

V. Phone/Fax

Practice location:
  • Phone: 918-912-2333
  • Fax:
Mailing address:
  • Phone: 918-483-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. LIZ BREWER
Title or Position: FINANCE MANAGER
Credential:
Phone: 918-483-0111