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General NPI Number Information
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NPI Number | 1366525255
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Entity Type | Organization
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Legal Business Name | FIVE STAR INTERLOCAL COOPERATIVE
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1405 E MOSES ST
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City | CUSHING
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State | OK
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Zip | 74023-3635
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Country | US
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Telephone | 918-225-5600
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Fax | 918-225-3026
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Provider Business Mailing Address
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Address Line | 1405 E MOSES ST
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City | CUSHING
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State | OK
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Zip | 74023-3635
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Country | US
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Telephone | 918-225-5600
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Fax | 918-225-3026
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. NANCY ANDERSON
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Credential |
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Telephone | 918-225-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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