Provider Demographics
NPI:1639621246
Name:CAREATC-OKC CARE
Entity Type:Organization
Organization Name:CAREATC-OKC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF FACILITIES AND PURCHASING
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7416
Mailing Address - Street 1:424 COLCORD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2215
Mailing Address - Country:US
Mailing Address - Phone:800-993-8244
Mailing Address - Fax:
Practice Address - Street 1:424 COLCORD DR
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-2215
Practice Address - Country:US
Practice Address - Phone:800-993-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care