Healthcare Provider Details

I. General information

NPI: 1639621246
Provider Name (Legal Business Name): CAREATC-OKC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2016
Last Update Date: 10/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 COLCORD DR SUITE A
OKLAHOMA CITY OK
73102-2215
US

IV. Provider business mailing address

424 COLCORD DR SUITE A
OKLAHOMA CITY OK
73102-2215
US

V. Phone/Fax

Practice location:
  • Phone: 800-993-8244
  • Fax:
Mailing address:
  • Phone: 800-993-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITH GUCWA
Title or Position: DIR OF FACILITIES AND PURCHASING
Credential:
Phone: 918-779-7416