# PRAGUE HEALTHCARE AUTHORITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prague Family Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881923290
- **Authorized official:** DIANNE M DYER (REVENUE CYCLE MANAGER)
- **Authorized official phone:** (405) 567-4922

## Contact information

- **Practice address:** 1322 KLABZUBA AVENUE, PRAGUE, OK 74864
- **Practice address phone:** (405) 567-4922
- **Practice address fax:** (405) 567-4290
- **Mailing address:** PO DRAWER S, 1322 KLABZUBA AVENUE, PRAGUE, OK 74864-1090
- **Mailing address phone:** (405) 567-4922
- **Mailing address fax:** (405) 567-4290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 2164 | OK | Yes |

## Other

- **Enumeration date:** 12/14/2009
- **Last updated:** 03/09/2021