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General NPI Number Information
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NPI Number | 1821043647
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTHCARE PLUS INC.
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 ARLINGTON ST SUITE B
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City | ADA
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State | OK
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Zip | 74820-4072
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Country | US
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Telephone | 580-436-1526
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Fax | 580-436-1354
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Provider Business Mailing Address
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Address Line | 1201 ARLINGTON ST SUITE B
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City | ADA
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State | OK
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Zip | 74820-4072
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Country | US
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Telephone | 580-436-1526
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Fax | 580-436-1354
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIMETHRIA LAURIE JACKSON
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Credential | MSN, ARNP
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Telephone | 580-436-1526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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