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General NPI Number Information
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NPI Number | 1609254507
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 101 E FERRY ST
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City | SALINA
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State | OK
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Zip | 74365-2988
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Country | US
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Telephone | 918-434-7440
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Fax | 918-434-7441
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Provider Business Mailing Address
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Address Line | PO BOX 751
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City | HULBERT
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State | OK
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Zip | 74441-0751
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Country | US
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Telephone | 918-772-3390
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Fax | 918-772-2244
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Authorized Official
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Title or Position | CEO
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Name | SCOTT ROSHENTHAL
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Credential |
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Telephone | 918-772-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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