Provider Demographics
NPI:1083286975
Name:SHORTGRASS COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:SHORTGRASS COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-688-2800
Mailing Address - Street 1:400 E SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-1436
Mailing Address - Country:US
Mailing Address - Phone:580-688-2800
Mailing Address - Fax:
Practice Address - Street 1:400 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-1436
Practice Address - Country:US
Practice Address - Phone:580-688-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy