NPIMap

Organization Active NPI

Edwin Fair Community Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Ponca City, OK
National Provider Identifier
1316997992
Registry record updated Oct 8, 2012
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 6TH St
Ponca City, OK 74601-2827
Phone
(580) 762-7561
Fax
(580) 762-2576
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2012

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

Authorized official

Name
Mrs. Misty Daniels
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 6TH St
Ponca City, OK 74601-2827

Mailing address

1500 North 6TH Street
Ponca City, OK 74601-2827
Phone (580) 762-7561

Other identifiers 6

IdentifierTypeStateIssuer
100749540QMedicaidOK
100749540UMedicaidOK
100749540BMedicaidOK
100749540WMedicaidOK
100749540RMedicaidOK
100749540LMedicaidOK

National Provider Directory

National Provider Directory

Locations

800 E 6th Ave
Ste B
Stillwater, OK 74074
Phone (405) 372-1250

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1316997992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 NORTH 6TH STREET",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012827",
            "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 6TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012827",
            "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": "2006-05-12",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "580-762-7561",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540Q",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540U",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540W",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540R",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540L",
            "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 Oct 8, 2012; 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.