Provider Demographics
NPI:1588648703
Name:COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:MARY MAHONEY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:405-769-3301
Mailing Address - Street 1:PO BOX 30589
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-3589
Mailing Address - Country:US
Mailing Address - Phone:405-769-3301
Mailing Address - Fax:405-769-3301
Practice Address - Street 1:12716 NE 36TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73140
Practice Address - Country:US
Practice Address - Phone:405-769-3301
Practice Address - Fax:405-769-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-1807333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK22105OtherOBN REGISTRATION NUMBER
OK1-1807OtherRETAIL PHARMACY PERMIT
OK100234680AMedicaid
OKAM5730660OtherDEA REGISTRATION NUMBER