Provider Demographics
NPI:1194730911
Name:COMMUNITY HEALTH CONNECTION INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH CONNECTION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HISCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-622-0641
Mailing Address - Street 1:9912 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-1620
Mailing Address - Country:US
Mailing Address - Phone:918-622-0641
Mailing Address - Fax:918-622-4814
Practice Address - Street 1:9912 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1620
Practice Address - Country:US
Practice Address - Phone:918-622-0641
Practice Address - Fax:918-622-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200082520AMedicaid
OK371841Medicare Oscar/Certification
OK800522425Medicare PIN