Organization
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA WARE (CEO)
(580) 925-3286
Entity
Organization
Contact information
Practice address
304 N MONTE VISTA STREET, ADA, OK 74820-7484
(580) 436-5111
(580) 925-9147
Mailing address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
(580) 925-2362
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
11/17/2023
Last updated
03/01/2024
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