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General NPI Number Information
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NPI Number | 1023804424
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Entity Type | Organization
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Legal Business Name | MONDUTA HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 1202 W CHEROKEE ST STE C
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City | WAGONER
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State | OK
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Zip | 74467-4629
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Country | US
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Telephone | 918-857-9932
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 W ELMIRA ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-0872
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Country | US
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Telephone | 918-857-9932
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERNEST MAINA
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Credential | NP
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Telephone | 918-857-9932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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