Healthcare Provider Details

I. General information

NPI: 1881499655
Provider Name (Legal Business Name): SOUTHERN PLAINS MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N PORTER AVE STE 101
NORMAN OK
73071-6443
US

IV. Provider business mailing address

2222 W IOWA AVE
CHICKASHA OK
73018-2738
US

V. Phone/Fax

Practice location:
  • Phone: 405-217-9997
  • Fax: 405-307-8520
Mailing address:
  • Phone: 405-224-8111
  • Fax: 405-594-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARESHKUMAR BOGHARA
Title or Position: OWNER
Credential:
Phone: 405-224-8111