Healthcare Provider Details

I. General information

NPI: 1598072050
Provider Name (Legal Business Name): HEALTH WATCH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 N PORTLAND AVE
OKLAHOMA CITY OK
73107-1532
US

IV. Provider business mailing address

1924 N PORTLAND AVE
OKLAHOMA CITY OK
73107-1532
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-1552
  • Fax: 405-949-1570
Mailing address:
  • Phone: 405-949-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number83300
License Number StateOK

VIII. Authorized Official

Name: MS. HELEN MBOH
Title or Position: NURSE PRACTITIONER-FAMILY
Credential: APRN-FNP-C
Phone: 405-949-1552