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General NPI Number Information
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NPI Number | 1114044369
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Entity Type | Organization
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Legal Business Name | STATE OF OKLAHOMA
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 123 ROBERT S KERR AVE STE 1702
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-6406
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Country | US
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Telephone | 405-426-8650
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Fax | 405-900-7498
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Provider Business Mailing Address
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Address Line | 123 ROBERT S KERR AVE STE 1702
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-6406
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Country | US
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Telephone | 405-426-8650
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Fax | 405-900-7498
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | MRS. GITANJALI PAI
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Credential | MD
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Telephone | 405-426-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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