Provider Demographics
NPI:1083786719
Name:SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Entity type:Organization
Organization Name:SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRE'YON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-490-3800
Mailing Address - Street 1:905 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1216
Mailing Address - Country:US
Mailing Address - Phone:580-226-5003
Mailing Address - Fax:580-226-4998
Practice Address - Street 1:905 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1216
Practice Address - Country:US
Practice Address - Phone:580-226-5003
Practice Address - Fax:580-226-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040 EMedicaid