Healthcare Provider Details

I. General information

NPI: 1609254507
Provider Name (Legal Business Name): NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E FERRY ST
SALINA OK
74365-2988
US

IV. Provider business mailing address

PO BOX 751
HULBERT OK
74441-0751
US

V. Phone/Fax

Practice location:
  • Phone: 918-434-7440
  • Fax: 918-434-7441
Mailing address:
  • Phone: 918-772-3390
  • Fax: 918-772-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SCOTT ROSHENTHAL
Title or Position: CEO
Credential:
Phone: 918-772-3390