| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 200 2nd Ave Sw, Miami, Oklahoma |
| Authorized Official Name and Position | C Bruce Lawrence (PRESIDENT/CEO) |
| Authorized Official Contact | 4059496066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 960400 Oklahoma City OK 73196-0400 Ph: () - | 200 2nd Ave Sw Miami OK 74354-6830 Ph: (918) 542-6611 |
| NPI Number | 1215043112 |
|---|---|
| Provider Enumeration Date | 08/22/2006 |
| Last Update Date | 07/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215043112 | NPI | - | NPPES |
| 010156008 | Medicaid | MO | |
| 100242850A | Medicaid | KS | |
| 100699440A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 2193 (Oklahoma) | Primary |
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