Provider Demographics
NPI:1205822830
Name:MORTON COMPREHENSIVE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MORTON COMPREHENSIVE HEALTH SERVICES, INC
Other - Org Name:EAST TULSA FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAUNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-295-6107
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-587-2171
Mailing Address - Fax:918-439-4205
Practice Address - Street 1:11511 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1815
Practice Address - Country:US
Practice Address - Phone:918-295-6185
Practice Address - Fax:918-439-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768880FMedicaid
OK1205822830OtherNPI
OKWCDPGOtherMEDICARE
OKWCDPGMedicare PIN
OK1205822830OtherNPI
OKWCDPGOtherMEDICARE