Healthcare Provider Details

I. General information

NPI: 1073549549
Provider Name (Legal Business Name): CENTURION HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 05/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 N GARNETT RD
OWASSO OK
74055-4401
US

IV. Provider business mailing address

PO BOX 2398
OWASSO OK
74055-9198
US

V. Phone/Fax

Practice location:
  • Phone: 918-609-5800
  • Fax: 918-609-5799
Mailing address:
  • Phone: 918-609-5800
  • Fax: 918-609-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number422
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number422
License Number StateOK

VIII. Authorized Official

Name: MR. DUKE E DIXON
Title or Position: PRESIDENT
Credential:
Phone: 918-609-5800