Provider Demographics
NPI:1477101715
Name:SOUTHERN PLAINS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTHERN PLAINS MEDICAL CENTER INC
Other - Org Name:PAULS VALLEY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-224-8111
Mailing Address - Street 1:2222 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2738
Mailing Address - Country:US
Mailing Address - Phone:405-825-3707
Mailing Address - Fax:
Practice Address - Street 1:200 MELVILLE DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-6610
Practice Address - Country:US
Practice Address - Phone:405-331-5128
Practice Address - Fax:405-867-4406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN PLAINS MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-29
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty