Provider Demographics
NPI:1407327851
Name:OKLAHOMA HEALTH AND WELLNESS 97
Entity Type:Organization
Organization Name:OKLAHOMA HEALTH AND WELLNESS 97
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-5513
Mailing Address - Street 1:5700 N PORTLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1662
Mailing Address - Country:US
Mailing Address - Phone:405-942-5513
Mailing Address - Fax:405-943-1661
Practice Address - Street 1:5700 N PORTLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1662
Practice Address - Country:US
Practice Address - Phone:405-942-5513
Practice Address - Fax:405-943-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service