Provider Demographics
NPI:1699318550
Name:COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-257-8029
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:OK
Mailing Address - Zip Code:74331-0705
Mailing Address - Country:US
Mailing Address - Phone:918-257-8029
Mailing Address - Fax:918-257-8042
Practice Address - Street 1:220 S MICKEY MANTLE BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:OK
Practice Address - Zip Code:74339-2924
Practice Address - Country:US
Practice Address - Phone:918-257-8029
Practice Address - Fax:918-257-8042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER OF NE OK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-23
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)