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General NPI Number Information
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NPI Number | 1932477288
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Entity Type | Organization
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Legal Business Name | US PHS FEDERAL BUREAU OF PRISONS
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 4205 W US HIGHWAY 66
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City | EL RENO
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State | OK
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Zip | 73036-6906
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Country | US
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Telephone | 405-319-7655
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 W US HIGHWAY 66 PO BOX 1000
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City | EL RENO
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State | OK
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Zip | 73036-6906
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Country | US
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Telephone | 405-319-7655
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Fax |
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Authorized Official
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Title or Position | IOP/IDC COORDINATOR
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Name | MR. BRENT A HAMILTON
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Credential | R.N.
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Telephone | 405-319-7655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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