NPIMap

Organization Active NPI

Edwin Fair CMHC

  • Community/Behavioral Health Agency
  • Ponca City, OK
National Provider Identifier
1972764736
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 CMHC
Practice address
201 E Chestnut Ave
Ponca City, OK 74601-4311
Phone
(580) 762-7561
Fax
(580) 762-2576
NPI assigned
Jun 24, 2008
Last updated
Oct 8, 2012By the provider in NPPES
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
Mr. Misty Dawn Daniels, MA
Title
Executive Director
Phone
(580) 762-7561

Specialties & licenses 1

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

Addresses

Primary practice location

201 E Chestnut Ave
Ponca City, OK 74601-4311

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
100749540EMedicaidOK
100749540TMedicaidOK
100749540XMedicaidOK

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.

Locations

201 E Chestnut Ave
Ponca City, OK 74601
Phone (580) 763-0931

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1972764736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E CHESTNUT AVE",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746014311",
            "telephone_number": "580-762-7561",
            "fax_number": "580-762-2576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWIN FAIR CMHC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "580-762-7561",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540E",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540T",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749540X",
            "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.