# MEDICAL CENTER OF SOUTHEAST OKLAHOMA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDICAL CENTER OF SE OKLAHOMA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083650600
- **Authorized official:** JOHN HARMS (PHCY DIR)
- **Authorized official phone:** (580) 924-3080

## Contact information

- **Practice address:** 1800 W UNIVERSITY BLVD, DURANT, OK 74701-3006
- **Practice address phone:** (580) 924-3080
- **Practice address fax:** (580) 920-0119
- **Mailing address:** 1800 W UNIVERSITY BLVD, DURANT, OK 74701-3006
- **Mailing address phone:** (580) 924-3080
- **Mailing address fax:** (580) 920-0119

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | — | — |
| 3336I0012X | Institutional Pharmacy | 274441 | OK | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 06/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100696610B | — | OK |
| 01 | — | 3720249 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |