| Providence Service Corp | |
|
117 E Main St Hugo OK 74743-6237 | |
| (580) 326-7477 | |
| (580) 326-6400 |
| Full Name | Providence Service Corp |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 117 E Main St, Hugo, Oklahoma |
| Authorized Official Name and Position | Tara A Myers (REHAB SPECIALIST) |
| Authorized Official Contact | 5803267477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Service Corp 117 E Main St Hugo OK 74743-6237 Ph: (580) 326-7477 | Providence Service Corp 117 E Main St Hugo OK 74743-6237 Ph: (580) 326-7477 |
| NPI Number | 1164721056 |
|---|---|
| Provider Enumeration Date | 03/18/2011 |
| Last Update Date | 03/18/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164721056 | NPI | - | NPPES |
| 100750190 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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