Provider Demographics
NPI:1093259673
Name:GREAT PLAIN CORRECTIONAL FACILITY
Entity Type:Organization
Organization Name:GREAT PLAIN CORRECTIONAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-542-3711
Mailing Address - Street 1:700 SUGAR CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047
Mailing Address - Country:US
Mailing Address - Phone:405-542-3711
Mailing Address - Fax:
Practice Address - Street 1:700 SUGAR CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:OK
Practice Address - Zip Code:73047
Practice Address - Country:US
Practice Address - Phone:405-542-3711
Practice Address - Fax:405-542-3743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEO CORRECTIONS& DETENTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0090341261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care