NPIMap

Organization Active NPI

Providence Service Corporation of Oklahoma

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Durant, OK
National Provider Identifier
1407916802
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
Practice address
134 N 12TH Ave
Durant, OK 74701-4718
Phone
(580) 924-6363
Fax
(580) 924-0379
NPI assigned
Dec 8, 2006
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

134 N 12TH Ave
Durant, OK 74701-4718

Mailing address

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

Other names 1

  • Providence of Oklahom 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

Locations

134 N 12th Ave
Durant, OK 74701
Phone (520) 570-1460

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": "1407916802",
    "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": "134 N 12TH AVE",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747014718",
            "telephone_number": "580-924-6363",
            "fax_number": "580-924-0379"
        }
    ],
    "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 Oklahom",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durant, 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.