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311 West Main Street Canton OK 73724 | |
(866) 926-6552 | |
(580) 886-3377 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 311 West Main Street, Canton, Oklahoma |
Authorized Official Name and Position | Robert Lobato (CEO) |
Authorized Official Contact | 4052228167 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 95207 Oklahoma City OK 73143-5207 Ph: (866) 926-6552 | 311 West Main Street Canton OK 73724 Ph: (866) 926-6552 |
NPI Number | 1932394236 |
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Provider Enumeration Date | 09/10/2007 |
Last Update Date | 09/10/2007 |
Identifier | Type | State | Issuer |
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1932394236 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | 251B00000X (Oklahoma) | Primary |