Provider Demographics
NPI:1326017492
Name:ADAIR COUNTY HEALTH CENTER,INC.
Entity Type:Organization
Organization Name:ADAIR COUNTY HEALTH CENTER,INC.
Other - Org Name:PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-696-3101
Mailing Address - Street 1:1401 W LOCUST ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3217
Mailing Address - Country:US
Mailing Address - Phone:918-696-4065
Mailing Address - Fax:918-696-5971
Practice Address - Street 1:1401 W LOCUST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3217
Practice Address - Country:US
Practice Address - Phone:918-696-4065
Practice Address - Fax:918-696-5971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAIR COUNTY HEALTH CENTER,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700030EMedicaid
OK600522020Medicare PIN
OK100700030EMedicaid