Organization
PRAGUE HEALTHCARE AUTHORITY
Active
Other names
Prague Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNE M DYER (REVENUE CYCLE MANAGER)
(405) 567-4922
Entity
Organization
Contact information
Practice address
1322 KLABZUBA AVENUE, PRAGUE, OK 74864
(405) 567-4922
(405) 567-4290
Mailing address
PO DRAWER S, 1322 KLABZUBA AVENUE, PRAGUE, OK 74864-1090
(405) 567-4922
(405) 567-4290
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
2164
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200231400C
—
OK
Enumeration date
12/14/2009
Last updated
03/09/2021
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