Healthcare Provider Details

I. General information

NPI: 1457983595
Provider Name (Legal Business Name): COMMUNITY HEALTH CONNECTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 E 31ST ST
TULSA OK
74146-7401
US

IV. Provider business mailing address

2321 E 3RD ST
TULSA OK
74104-1831
US

V. Phone/Fax

Practice location:
  • Phone: 918-710-4460
  • Fax: 918-710-4461
Mailing address:
  • Phone: 918-710-4460
  • Fax: 918-710-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARY BETH MILLER
Title or Position: FINANCE
Credential:
Phone: 918-622-0641