Provider Demographics
NPI:1376585034
Name:CENTENNIAL HEALTH, PC
Entity Type:Organization
Organization Name:CENTENNIAL HEALTH, PC
Other - Org Name:OKLAHOMA CITY CLINIC, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-280-5634
Mailing Address - Street 1:PO BOX 659506
Mailing Address - Street 2:SECTION 4142
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265
Mailing Address - Country:US
Mailing Address - Phone:405-280-5634
Mailing Address - Fax:405-280-5661
Practice Address - Street 1:1720 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-3324
Practice Address - Country:US
Practice Address - Phone:405-280-5550
Practice Address - Fax:405-280-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100728970AMedicaid
OK0571360002Medicare NSC
OKWCBBB1Medicare PIN