Healthcare Provider Details

I. General information

NPI: 1598022899
Provider Name (Legal Business Name): ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W MARTIN LUTHER KING ST
MUSKOGEE OK
74401
US

IV. Provider business mailing address

PO BOX 334
PORTER OK
74454-0334
US

V. Phone/Fax

Practice location:
  • Phone: 918-483-0111
  • Fax: 918-483-0112
Mailing address:
  • Phone: 918-483-0111
  • Fax: 918-483-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SONYA L SMITH
Title or Position: CEO
Credential:
Phone: 918-483-0111