Provider Demographics
NPI:1093123101
Name:MELTON HEALTH AND MEDICAL SERVICES
Entity Type:Organization
Organization Name:MELTON HEALTH AND MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-764-9300
Mailing Address - Street 1:PO BOX 35264
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74153-0264
Mailing Address - Country:US
Mailing Address - Phone:918-764-9300
Mailing Address - Fax:918-764-9275
Practice Address - Street 1:1129 S ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4859
Practice Address - Country:US
Practice Address - Phone:918-764-9300
Practice Address - Fax:918-764-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty