Healthcare Provider Details

I. General information

NPI: 1942053210
Provider Name (Legal Business Name): PHILLIP FOSTER CPRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ALAMEDA ST
NORMAN OK
73071-5229
US

IV. Provider business mailing address

4202 COUNTY STREET 2800
RUSH SPRINGS OK
73082-3090
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-5100
  • Fax:
Mailing address:
  • Phone: 580-861-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number320543
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: