MEDICARE: MORTON COMPREHENSIVE HEALTH SERVICES, INC

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
1	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	WCDPG	OTHER	OK	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1205822830	OTHER	OK	NPI

General Provider Information

NPI Number	:	1205822830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORTON COMPREHENSIVE HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	1334 N LANSING AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-5907
Country	:	US
Telephone Number	:	918-587-2171
Fax Number	:	918-439-4205

Provider Business Practice Location Address
First Line	:	11511 E 21ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-1815
Country	:	US
Telephone Number	:	918-295-6185
Fax Number	:	918-439-4205

Authorized Official
Title or Position	:	CFO
Name	:	SAUNYA MOORE
Credential	:
Telephone Number	:	918-295-6107

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/24/2019

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Directions to “MORTON COMPREHENSIVE HEALTH SERVICES, INC ” Practice Location

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