Healthcare Provider Details

I. General information

NPI: 1063681856
Provider Name (Legal Business Name): FITCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N SANTA FE AVE
OKLAHOMA CITY OK
73118-7519
US

IV. Provider business mailing address

431 NW 44TH ST
OKLAHOMA CITY OK
73118-8222
US

V. Phone/Fax

Practice location:
  • Phone: 405-831-4568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD PATRICK HUTTON
Title or Position: PRESIDENT
Credential: MA
Phone: 405-831-4568