Provider Demographics
NPI:1225304744
Name:CAH ACQUISITION COMPANY 9 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 9 LLC
Other - Org Name:VICI COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-922-7361
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:SEILING
Mailing Address - State:OK
Mailing Address - Zip Code:73663-0720
Mailing Address - Country:US
Mailing Address - Phone:580-922-7361
Mailing Address - Fax:580-922-7718
Practice Address - Street 1:104 W. BROADWAY
Practice Address - Street 2:
Practice Address - City:VICI
Practice Address - State:OK
Practice Address - Zip Code:73859-5900
Practice Address - Country:US
Practice Address - Phone:580-995-3004
Practice Address - Fax:580-995-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200287200CMedicaid
OK373469Medicare Oscar/Certification