Provider Demographics
NPI:1578513792
Name:LOVE COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:LOVE COUNTY HEALTH CENTER
Other - Org Name:MERCY HEALTH LOVE COUNTY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-273-3347
Mailing Address - Street 1:301 WANDA ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-1229
Mailing Address - Country:US
Mailing Address - Phone:580-276-2400
Mailing Address - Fax:580-276-4358
Practice Address - Street 1:301 WANDA ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-1229
Practice Address - Country:US
Practice Address - Phone:580-276-2400
Practice Address - Fax:580-276-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK373429207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK373429Medicare Oscar/Certification