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NPI Code Detail

MEDICARE: STATE OF OKLAHOMA

MEDICARE: STATE OF OKLAHOMA
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261QM2500XMedical Specialty Clinic/Center
3283Q00000XPsychiatric Hospital

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578580916
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF OKLAHOMA
Provider Business Mailing Address
First Line : 2323 S HARVARD AVE
Second Line :
City : TULSA
State : OK
Zip : 74114-3301
Country : US
Telephone Number : 918-293-2140
Fax Number : 918-293-2195
Provider Business Practice Location Address
First Line : 2323 S HARVARD AVE
Second Line :
City : TULSA
State : OK
Zip : 74114-3301
Country : US
Telephone Number : 918-293-2140
Fax Number : 918-712-7164
Authorized Official
Title or Position : INTERIM EXECUTIVE DIRECTOR
Name : AUTUMN NICKELSON
Credential :
Telephone Number : 580-256-8615
Provider Enumeration Date : 07/15/2006
Last Update Date : 09/06/2023

Similar Medicare Providers

1740143353 — HUNTER GAGE HATHAWAY
Practice Location Address:
2323 S HARVARD AVE
TULSA, OK
74114-3301
Practice Phone: 918-293-2140
Practice Fax:
1649330150 — DR. LOUISE PRICE DO
Practice Location Address:
2323 S HARVARD AVE
TULSA, OK
74114-3301
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Practice Fax: 918-712-7164
1760543714 — DR. J BRYAN CATES DO
Practice Location Address:
2323 S HARVARD AVE
TULSA, OK
74114-3301
Practice Phone: 918-712-4301
Practice Fax: 918-560-1399
1528267119 — MR. SEBASTIAO IVAN LOPES MS, LPC, LADC
Practice Location Address:
2323 S HARVARD AVE
TULSA, OK
74114-3301
Practice Phone: 918-293-2140
Practice Fax: 918-712-7164
1619169893 — MS. AMBER JO SIEGFRIED LPC
Practice Location Address:
2323 S HARVARD AVE
TULSA, OK
74114-3301
Practice Phone: 918-293-2140
Practice Fax: 918-712-7164
1902057110 — MR. VINCENT PAUL PEOPLES LCSW
Practice Location Address:
2323 S HARVARD AVE
TULSA, OK
74114-3301
Practice Phone: 918-293-2140
Practice Fax:

Directions to “STATE OF OKLAHOMA ” Practice Location

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