Organization
FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC
Active
Parent organization
FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC
Authorized official
ASHLEY WELLS (CREDENTIALING OFFICER)
(580) 387-0509
Entity
Organization
Contact information
Practice address
457 S MISSISSIPPI AVE, ATOKA, OK 74525-2500
(580) 889-4746
(580) 889-4735
Mailing address
610 E 24TH ST, TISHOMINGO, OK 73460-3245
(580) 371-2343
(580) 371-3614
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200018910A
—
OK
Enumeration date
03/05/2014
Last updated
11/13/2024
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