MEDICARE: ODMHSAS

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	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1386983104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODMHSAS

Provider Business Mailing Address
First Line	:	9803 WELCH DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2814
Country	:	US
Telephone Number	:	405-255-0649
Fax Number	:

Provider Business Practice Location Address
First Line	:	9803 WELCH DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2814
Country	:	US
Telephone Number	:	405-255-0649
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR
Name	:	MR. BRYAN HIEL
Credential	:	ASSISTANT DIRECTOR
Telephone Number	:	405-343-2924

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	02/14/2013

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Directions to “ODMHSAS ” Practice Location

Language	Start Address	Practice Location

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