| Odmhsas | |
|
405 E Excelsior Ave Vinita OK 74301-4226 | |
| (918) 256-6476 | |
| Not Available |
| Full Name | Odmhsas |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 405 E Excelsior Ave, Vinita, Oklahoma |
| Authorized Official Name and Position | Dominque M Lee (RSS) |
| Authorized Official Contact | 9189150309 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Odmhsas 405 E Excelsior Ave Vinita OK 74301-4226 Ph: () - | Odmhsas 405 E Excelsior Ave Vinita OK 74301-4226 Ph: (918) 256-6476 |
| NPI Number | 1942678388 |
|---|---|
| Provider Enumeration Date | 09/02/2015 |
| Last Update Date | 09/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942678388 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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