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Organization
PASSPORT HEALTH OF OKLAHOMA
Active
Organization
PASSPORT HEALTH OF OKLAHOMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY SUE HICKS M.S., RDN, LD (DIETITIAN)
(405) 606-1086
Entity
Organization
Contact information
Practice address
3000 UNITED FOUNDERS BLVD, SUITE 137, OKLAHOMA CITY, OK 73112-3958
(405) 563-8961
Mailing address
3000 UNITED FOUNDERS BLVD, SUITE 137, OKLAHOMA CITY, OK 73112-3958
(405) 563-8961
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
LD2080
OK
Other
Enumeration date
08/19/2015
Last updated
08/19/2015
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