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General NPI Number Information
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NPI Number | 1194816074
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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 | 09/27/2006
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 900 E MAIN ST
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City | NORMAN
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State | OK
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Zip | 73071-5305
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Country | US
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Telephone | 405-573-6600
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Fax | 405-573-3960
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Provider Business Mailing Address
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Address Line | 900 E MAIN ST
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City | NORMAN
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State | OK
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Zip | 73071-5305
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Country | US
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Telephone | 405-573-6600
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Fax | 405-573-3960
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LORI E JORDAN
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Credential | MBA
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Telephone | 405-573-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 7-1002
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State | OK
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