| Family Health Center Of Southern Oklahoma Inc | |
|
21 N Main St Kingston OK 73439-6562 | |
| (580) 564-7885 | |
| (580) 564-7902 |
| Full Name | Family Health Center Of Southern Oklahoma Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 21 N Main St, Kingston, Oklahoma |
| Authorized Official Name and Position | Ashley Wells (CREDENTIALING OFFICER) |
| Authorized Official Contact | 5803870509 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Health Center Of Southern Oklahoma Inc 610 E 24th St Tishomingo OK 73460-3245 Ph: (580) 371-2343 | Family Health Center Of Southern Oklahoma Inc 21 N Main St Kingston OK 73439-6562 Ph: (580) 564-7885 |
| NPI Number | 1982267910 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 08/21/2024 |
| Medicare PECOS PAC ID | 4284537457 |
|---|---|
| Medicare Enrollment ID | O20191101000097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982267910 | NPI | - | NPPES |
| 200018910G | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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