Provider Demographics
NPI:1073549549
Name:CENTURION HEALTH SYSTEMS, INC
Entity Type:Organization
Organization Name:CENTURION HEALTH SYSTEMS, INC
Other - Org Name:MERCY REGIONAL OF OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-609-5800
Mailing Address - Street 1:PO BOX 2398
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-9198
Mailing Address - Country:US
Mailing Address - Phone:918-609-5800
Mailing Address - Fax:918-609-5799
Practice Address - Street 1:9106 N GARNETT RD
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4401
Practice Address - Country:US
Practice Address - Phone:918-609-5800
Practice Address - Fax:918-609-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK422341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200097940AMedicaid
OK=========001OtherBLUE CROSS BLUE SHIELD
OK200097940AMedicaid