Organization
IV HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKKI BUSELLATO (CREDENTIALING/CONTRACTING)
(405) 703-3614
Entity
Organization
Contact information
Practice address
1107 WALNUT DR, ARDMORE, OK 73401-2354
(405) 703-3614
Mailing address
1107 WALNUT DR, ARDMORE, OK 73401-2354
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/16/2017
Last updated
02/16/2017
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