Healthcare Provider Details

I. General information

NPI: 1225298235
Provider Name (Legal Business Name): ARNEICE UPCHURCH BS, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SW 15TH ST
OKLAHOMA CITY OK
73108-6803
US

IV. Provider business mailing address

1607 SW 15TH ST
OKLAHOMA CITY OK
73108-6803
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-0508
  • Fax: 405-616-5678
Mailing address:
  • Phone: 405-634-0508
  • Fax: 405-616-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number20646
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: