Provider Demographics
NPI:1073938999
Name:SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF ADMINSTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-745-9610
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-1710
Mailing Address - Country:US
Mailing Address - Phone:580-745-9610
Mailing Address - Fax:580-745-9891
Practice Address - Street 1:1213 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4229
Practice Address - Country:US
Practice Address - Phone:580-326-7400
Practice Address - Fax:580-326-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100708380Medicaid