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General NPI Number Information
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NPI Number | 1770766610
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Entity Type | Organization
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Legal Business Name | EBENEZER HEALTHCARE SERVICES,
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 10444 GREENBRIAR PLACE SUITE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7660
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Country | US
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Telephone | 405-378-2119
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Fax | 405-759-7022
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Provider Business Mailing Address
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Address Line | 10444 GREENBRIAR PLACE, SUITE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7660
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Country | US
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Telephone | 405-378-2119
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Fax | 405-759-7022
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Authorized Official
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Title or Position | CEO
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Name | MRS. MARIA AGNES E SMITH
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Credential | ARNP,BC
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Telephone | 405-378-2119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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