Healthcare Provider Details

I. General information

NPI: 1679661128
Provider Name (Legal Business Name): VA HOSPITAL AND CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-278-3109
  • Fax:
Mailing address:
  • Phone: 405-278-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number9938
License Number StateOK

VIII. Authorized Official

Name: DANNY GARRETT
Title or Position: ADPAC
Credential: RPH
Phone: 405-278-5658