EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL - NPI NUMBER 1679822175

Summary

Provider Name: EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL

NPI Number: 1679822175

Clasification: Clinic/Center (261QD0000X)

Specialization: Dental

Address:
217 S 5TH ST
HENRYETTA, OK
ZIP 74437

Phone Number: (918) 652-3676



Detailed Information

EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL is a dental clinic/center in Henryetta, OK. The assigned NPI number for this provider is 1679822175 and is registered as an organization entity type.

The provider's business address is:

217 S 5TH ST
HENRYETTA, OK
ZIP 74437-222
Phone: (918) 652-3676
Fax: (918) 652-7612

The provider's authorized official is Donna Dyer .
The authorized official title is Ceo and has the following contact phone number (405) 452-3151.

The enumeration date for this NPI number is 8/30/2012 and was last updated on 8/30/2012.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QD0000X Clinic/Center Dental Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1679822175 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 217 S 5TH ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name HENRYETTA The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name OK The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 744375222 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 9186523676 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 9186527612 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 8/30/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 8/30/2012 The date that a record was last updated or changed.
14 Authorized Official Last Name DYER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name DONNA The first name of the authorized official.
16 Authorized Official Title or Position CEO The title or position of the authorized official.
17 Authorized Official Telephone Number 4054523151 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 261QD0000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Organization Subpart Y
21 Parent Organization LBN EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
22 Parent Organization TIN

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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