| Grand Lake Medical Health Center | |
|
405 E Excelsior Ave Vinita OK 74301-4226 | |
| (918) 256-6476 | |
| Not Available |
| Full Name | Grand Lake Medical Health Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 405 E Excelsior Ave, Vinita, Oklahoma |
| Authorized Official Name and Position | Larry Smith (CEO) |
| Authorized Official Contact | 9182731841 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Lake Medical Health Center 114 W Delaware Ave Nowata OK 74048-2601 Ph: (918) 273-1841 | Grand Lake Medical Health Center 405 E Excelsior Ave Vinita OK 74301-4226 Ph: (918) 256-6476 |
| NPI Number | 1679983696 |
|---|---|
| Provider Enumeration Date | 04/29/2014 |
| Last Update Date | 07/31/2020 |
| Certification Date | 07/31/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679983696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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