Healthcare Provider Details

I. General information

NPI: 1639480775
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 16 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 6TH ST
STIGLER OK
74462-1617
US

IV. Provider business mailing address

901 NW 6TH ST
STIGLER OK
74462-1617
US

V. Phone/Fax

Practice location:
  • Phone: 918-967-8814
  • Fax: 918-967-8462
Mailing address:
  • Phone: 918-967-8814
  • Fax: 918-967-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH S MORRIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 918-967-4682