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General NPI Number Information
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NPI Number | 1871108514
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Entity Type | Organization
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Legal Business Name | POTEAU COMMUNITY CARE
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 1301 S BROADWAY AVE STE 2
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City | POTEAU
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State | OK
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Zip | 74953-5268
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Country | US
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Telephone | 918-564-2010
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Fax | 918-564-2080
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Provider Business Mailing Address
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Address Line | 107 E DORA LN
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City | POTEAU
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State | OK
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Zip | 74953-5518
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Country | US
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Telephone | 191-883-9969
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STEVE YOUNG
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Credential | RN
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Telephone | 918-564-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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