Provider Demographics
NPI:1598022899
Name:ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS,INC.
Entity Type:Organization
Organization Name:ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS,INC.
Other - Org Name:MUSKOGEE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-483-0111
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:OK
Mailing Address - Zip Code:74454-0334
Mailing Address - Country:US
Mailing Address - Phone:918-483-0111
Mailing Address - Fax:918-483-0112
Practice Address - Street 1:110 W MARTIN LUTHER KING ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-483-0111
Practice Address - Fax:918-483-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty