Healthcare Provider Details

I. General information

NPI: 1316196546
Provider Name (Legal Business Name): EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MAIN ST
WETUMKA OK
74883-4015
US

IV. Provider business mailing address

PO BOX 236
WETUMKA OK
74883-0236
US

V. Phone/Fax

Practice location:
  • Phone: 405-452-5400
  • Fax: 405-452-3379
Mailing address:
  • Phone: 405-452-5400
  • Fax: 405-452-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number40-5941
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DONNA DYER
Title or Position: CEO
Credential:
Phone: 405-452-3151