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General NPI Number Information
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NPI Number | 1124853775
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Entity Type | Organization
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Legal Business Name | COMMUNITYCARE GOVERNMENT PROGRAMS, INC., D/B/A COMMUNITYCARE CHOICE, I
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 2 W 2ND ST STE 100
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City | TULSA
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State | OK
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Zip | 74103-3121
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Country | US
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Telephone | 918-594-5295
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Fax |
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Provider Business Mailing Address
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Address Line | 2 W 2ND ST STE 100
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City | TULSA
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State | OK
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Zip | 74103-3121
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Country | US
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Telephone | 918-594-5295
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. JOSIAH SUTTON
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Credential |
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Telephone | 918-594-6529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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