Provider Demographics
NPI:1184178675
Name:CAREATC - OWASSO
Entity Type:Organization
Organization Name:CAREATC - OWASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PURCHASING AND FACILITI
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7416
Mailing Address - Street 1:8751 N 117TH EAST AVE
Mailing Address - Street 2:UNIT H
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2098
Mailing Address - Country:US
Mailing Address - Phone:800-993-8244
Mailing Address - Fax:855-568-0489
Practice Address - Street 1:8751 N 117TH EAST AVE
Practice Address - Street 2:UNIT H
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2098
Practice Address - Country:US
Practice Address - Phone:800-993-8244
Practice Address - Fax:855-568-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care