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General NPI Number Information
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NPI Number | 1144698036
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Entity Type | Organization
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Legal Business Name | TEXOMA RURAL HEALTH CENTER
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 508 E 24TH ST
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City | TISHOMINGO
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State | OK
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Zip | 73460-3214
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Country | US
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Telephone | 580-371-9117
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Fax |
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Provider Business Mailing Address
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Address Line | 127 N 3RD AVE
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City | DURANT
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State | OK
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Zip | 74701-4700
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Country | US
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Telephone | 580-745-9535
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Fax | 580-745-9891
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Authorized Official
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Title or Position | CEO
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Name | VIRGINIA MARIE RAGAN
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Credential |
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Telephone | 580-745-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21084
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License Number State | OK
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