Healthcare Provider Details

I. General information

NPI: 1184168643
Provider Name (Legal Business Name): OKLAHOMA STATE DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 10TH ST
OKLAHOMA CITY OK
73117-1207
US

IV. Provider business mailing address

1000 NE 10TH ST
OKLAHOMA CITY OK
73117-1207
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4476
  • Fax:
Mailing address:
  • Phone: 405-271-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number120947
License Number StateOK

VIII. Authorized Official

Name: MRS. JILL NOBLES-BOTKIN
Title or Position: DIRECTOR
Credential: CNM
Phone: 405-271-4476