NPIMap

Organization Active NPI

Edwin Fair Community Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Ponca City, OK
National Provider Identifier
1043382484
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EDWIN FAIR COMMUNITY MENTAL HEALTH CENTER, INC.
Practice address
1500 N 5TH St
Ponca City, OK 74601-2758
Phone
(580) 762-7561
Fax
(580) 762-2576
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

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

Authorized official

Name
Mrs. Misty D Daniels, MA
Title
Executive Director
Phone
(580) 762-7561

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1500 N 5TH St
Ponca City, OK 74601-2758

Mailing address

1500 N 5TH St
Ponca City, OK 74601-2758
Phone (580) 762-7561

Other identifiers 1

IdentifierTypeStateIssuer
100749540DMedicaidOK

National Provider Directory

National Provider Directory
Tax ID family
Edwin Fair CMHC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1043382484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N 5TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012758",
            "telephone_number": "580-762-7561",
            "fax_number": "580-762-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N 5TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012758",
            "telephone_number": "580-762-7561",
            "fax_number": "580-762-2576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWIN FAIR COMMUNITY MENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2011-06-28",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "580-762-7561",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponca City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; 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.