Healthcare Provider Details

I. General information

NPI: 1811208960
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

401 NW H ST
STIGLER OK
74462-1625
US

IV. Provider business mailing address

PO BOX 728
STIGLER OK
74462-0728
US

V. Phone/Fax

Practice location:
  • Phone: 918-967-4682
  • Fax: 918-967-2332
Mailing address:
  • Phone: 918-967-4682
  • Fax: 918-967-2332

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