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NPI Code Detail

MEDICARE: OKLAHOMA NEUROSCIENCE AND ADDICTIONOLOGY

MEDICARE: OKLAHOMA NEUROSCIENCE AND ADDICTIONOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/Center2141OK

General Provider Information

NPI Number : 1043433501
Entity Type Code : Organization
Provider Name (Legal Business Name) : OKLAHOMA NEUROSCIENCE AND ADDICTIONOLOGY
Provider Business Mailing Address
First Line : 900 E HARTFORD AVE STE A
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-2011
Country : US
Telephone Number : 580-762-4103
Fax Number : 580-762-4103
Provider Business Practice Location Address
First Line : 900 E HARTFORD AVE STE A
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-2011
Country : US
Telephone Number : 580-762-4103
Fax Number : 580-762-4103
Authorized Official
Title or Position : PHYSICIAN
Name : DR. JAMES EUGENE HALL
Credential : PH.D.
Telephone Number : 580-762-4103
Provider Enumeration Date : 04/11/2007
Last Update Date : 08/22/2020

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Directions to “OKLAHOMA NEUROSCIENCE AND ADDICTIONOLOGY ” Practice Location

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