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General NPI Number Information
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NPI Number | 1285134825
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Entity Type | Organization
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Legal Business Name | BAPTIST HEALTHCARE OF OKLAHOMA, LLC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 200 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6830
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Country | US
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Telephone | 918-540-7502
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Fax |
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Provider Business Mailing Address
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Address Line | 200 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6830
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Country | US
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Telephone | 918-540-7502
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Fax |
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Authorized Official
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Title or Position | INTERIM VICE PRESIDENT
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Name | MITZI MCCULLOCK
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Credential |
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Telephone | 405-713-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 21-6864
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License Number State | OK
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