Provider Demographics
NPI:1477713097
Name:OKLAHOMA CITY-COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:OKLAHOMA CITY-COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-425-4332
Mailing Address - Street 1:921 NE 23RD ST
Mailing Address - Street 2:ATTN: FINANCE DEPARTMENT
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7936
Mailing Address - Country:US
Mailing Address - Phone:405-427-8651
Mailing Address - Fax:
Practice Address - Street 1:4330 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5711
Practice Address - Country:US
Practice Address - Phone:405-419-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749440 BMedicaid