Provider Demographics
NPI:1598072050
Name:HEALTH WATCH MEDICAL CENTER
Entity Type:Organization
Organization Name:HEALTH WATCH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER-FAMILY
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MBOH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP-C
Authorized Official - Phone:405-949-1552
Mailing Address - Street 1:1924 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1532
Mailing Address - Country:US
Mailing Address - Phone:405-949-1552
Mailing Address - Fax:
Practice Address - Street 1:1924 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1532
Practice Address - Country:US
Practice Address - Phone:405-949-1552
Practice Address - Fax:405-949-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-04
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83300261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK83300OtherLICENSE #