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General NPI Number Information
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NPI Number | 1811801707
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Entity Type | Organization
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Legal Business Name | CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 1904 W BROADWAY AVE STE 1
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City | SULPHUR
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State | OK
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Zip | 73086-4233
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Country | US
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Telephone | 580-436-5111
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Fax | 580-436-1159
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Provider Business Mailing Address
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Address Line | 527 W 3RD ST
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City | KONAWA
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State | OK
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Zip | 74849-1415
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Country | US
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Telephone | 580-925-3286
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Fax | 580-925-2362
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Authorized Official
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Title or Position | CEO
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Name | BRENDA WARE
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Credential |
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Telephone | 580-925-3286
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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 | NULL
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