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General NPI Number Information
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NPI Number | 1760933634
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Entity Type | Organization
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Legal Business Name | MCO HEALTH PLANS, INC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 1908 12TH AVE NW SUITE B
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City | ARDMORE
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State | OK
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Zip | 73401-1196
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Country | US
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Telephone | 580-223-8805
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Fax | 580-223-8885
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Provider Business Mailing Address
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Address Line | 1908 12TH AVE NW SUITE B
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City | ARDMORE
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State | OK
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Zip | 73401-1196
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Country | US
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Telephone | 580-223-8805
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Fax | 580-223-8885
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL D HARDIMON
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Credential | MBA, BSN, RN
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Telephone | 828-989-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number |
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License Number State | OK
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