Provider Demographics
NPI:1629302609
Name:SOUTH CENTRAL MEDICAL AND RESOURCE CENTER
Entity Type:Organization
Organization Name:SOUTH CENTRAL MEDICAL AND RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-756-1414
Mailing Address - Street 1:210 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-4048
Mailing Address - Country:US
Mailing Address - Phone:405-756-1414
Mailing Address - Fax:405-756-1162
Practice Address - Street 1:210 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-4048
Practice Address - Country:US
Practice Address - Phone:405-756-1414
Practice Address - Fax:405-756-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0063717261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center