Individual
JOHNATHAN CULVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
Mailing address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 801-3955
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9JIC
9JIC
OK
Enumeration date
02/03/2022
Last updated
02/03/2022
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