Provider Demographics
NPI:1215577622
Name:SOUTHERN OKLAHOMA TREATMENT SERICES, INC.
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA TREATMENT SERICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-795-6377
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-1710
Mailing Address - Country:US
Mailing Address - Phone:580-795-6377
Mailing Address - Fax:
Practice Address - Street 1:317 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1312
Practice Address - Country:US
Practice Address - Phone:405-321-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health