| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | #2 Broadlawn, Ardmore, Oklahoma |
| Authorized Official Name and Position | Robert Lee (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5802235070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 189 Ardmore OK 73402-0189 Ph: (580) 223-5070 | #2 Broadlawn Ardmore OK 73402-1722 Ph: (580) 223-4500 |
| NPI Number | 1922266964 |
|---|---|
| Provider Enumeration Date | 05/27/2008 |
| Last Update Date | 05/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922266964 | NPI | - | NPPES |
| 200129610 C | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Oklahoma) | Primary |
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