=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255648580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2010
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113653 OLD HIGHWAY 69
-----------------------------------------------------
City | CHECOTAH
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74426-8802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-565-4235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1709
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73439-1709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-564-7374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | BRE'YON JAMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-490-1352
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------