STATE OF OKLAHOMA NPI 1619012515

NPI Information

NPI: 1619012515
Provider Name: STATE OF OKLAHOMA

Doing Business As: JIM TALIAFERRO CMHC

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
602 SW 38TH STREET
LAWTON, OK
ZIP 73505
Phone: (580) 248-5780
Get Directions

STATE OF OKLAHOMA is a mental health (including community mental health center) clinic center in Lawton, OK. STATE OF OKLAHOMA NPI is 1619012515. The provider is registered as an organization entity type.
The provider Is Doing Business As Jim Taliaferro Cmhc.

The provider's business location address is:

602 SW 38TH STREET
LAWTON, OK
ZIP 73505-912
Phone: (580) 248-5780
Fax: (580) 353-3202

The provider's authorized official is Terri Lee .
The authorized official title is Executive Director and has the following contact phone number (580) 250-2640.

The CLIA number assigned to this NPI record is 37D0717676 - hospital with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/20/2007 and was last updated on 1/30/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	261QM2500X	Clinic/Center	Medical Specialty	0005111	OKLAHOMA	No
2	261QM2500X	Clinic/Center	Medical Specialty			No
3	251S00000X	Community/Behavioral Health				No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	0005111	OKLAHOMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	WCDLG	OTHER	OKLAHOMA	MEDICARE PART B PROVIDER NUMBER
2	100677270A	MEDICAID	OKLAHOMA
3	100755860A	MEDICAID	OKLAHOMA
4	100688870A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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