Healthcare Provider Details

I. General information

NPI: 1609801836
Provider Name (Legal Business Name): JEFFERSON COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 6TH STREET
RYAN OK
73565-0157
US

IV. Provider business mailing address

PO BOX 157
RYAN OK
73565-0157
US

V. Phone/Fax

Practice location:
  • Phone: 580-757-2451
  • Fax:
Mailing address:
  • Phone: 580-757-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2233
License Number StateOK

VIII. Authorized Official

Name: MRS. PHYLLIS JANE MCDOWELL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 580-228-2344