Provider Demographics
NPI:1285134825
Name:BAPTIST HEALTHCARE OF OKLAHOMA, LLC
Entity type:Organization
Organization Name:BAPTIST HEALTHCARE OF OKLAHOMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-713-5512
Mailing Address - Street 1:200 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6830
Mailing Address - Country:US
Mailing Address - Phone:918-540-7502
Mailing Address - Fax:
Practice Address - Street 1:200 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6830
Practice Address - Country:US
Practice Address - Phone:918-540-7502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21-6864333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy