Healthcare Provider Details

I. General information

NPI: 1174565519
Provider Name (Legal Business Name): CENTRAL HEALTH SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MACARTHUR ST
SHAWNEE OK
74804-2027
US

IV. Provider business mailing address

PO BOX 904
PRAGUE OK
74864-0904
US

V. Phone/Fax

Practice location:
  • Phone: 405-273-5208
  • Fax: 405-273-5235
Mailing address:
  • Phone: 405-567-0904
  • Fax: 405-567-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number10-4753
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number10-S-988
License Number StateOK

VIII. Authorized Official

Name: MRS. DONNA M HARVEY
Title or Position: OWNER
Credential:
Phone: 405-567-0904