=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265201446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OKLAHOMA COMMUNITY HEALTH CENTERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2023
-----------------------------------------------------
Last Update Date | 12/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6501 BROADWAY EXT STE 200
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73116-8249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-424-2282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6501 BROADWAY EXT STE 200
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73116-8249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-424-2282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | FIONA MCINTOSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-252-8709
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------