Provider Demographics
NPI:1629133863
Name:SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Other - Org Name:MCALESTER FAMILY TREATMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-371-3672
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-1710
Mailing Address - Country:US
Mailing Address - Phone:580-371-3672
Mailing Address - Fax:580-371-3651
Practice Address - Street 1:1600 N D ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-2314
Practice Address - Country:US
Practice Address - Phone:918-426-1614
Practice Address - Fax:918-426-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040 SMedicaid