Provider Demographics
NPI:1720819725
Name:FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC
Entity type:Organization
Organization Name:FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-371-0203
Mailing Address - Street 1:610 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-3245
Mailing Address - Country:US
Mailing Address - Phone:580-371-0203
Mailing Address - Fax:580-371-0205
Practice Address - Street 1:457 S MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2500
Practice Address - Country:US
Practice Address - Phone:580-207-3800
Practice Address - Fax:580-207-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy