NPIMap

Organization Active NPI

Providence Service Corporation of Oklahoma

Doing business as Providence of Oklahoma

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lawton, OK
National Provider Identifier
1033279443
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PROVIDENCE SERVICE CORPORATION OF OKLAHOMA
Doing business as
Providence of Oklahoma
Practice address
4645 W Gore Blvd Ste 5
Lawton, OK 73505-5962
Phone
(580) 355-6800
Fax
(580) 355-0666
NPI assigned
Dec 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Breeann Marie Hoerning
Title
Ar and Billing Manager
Phone
(520) 747-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

4645 W Gore Blvd Ste 5
Lawton, OK 73505-5962

Mailing address

620 N Craycroft Rd
Tucson, AZ 85711-1448
Phone (520) 747-6600

Other names 1

  • Providence of Oklahoma Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Providence Service Corporation of Oklahoma15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033279443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N CRAYCROFT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857111448",
            "telephone_number": "520-747-6600",
            "fax_number": "520-747-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 W GORE BLVD STE 5",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735055962",
            "telephone_number": "580-355-6800",
            "fax_number": "580-355-0666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SERVICE CORPORATION OF OKLAHOMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOERNING",
        "authorized_official_first_name": "BREEANN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "AR AND BILLING MANAGER",
        "authorized_official_telephone_number": "520-747-6600"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence of Oklahoma",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.