Provider Demographics
NPI:1699025973
Name:GREAT SALT PLAINS HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:GREAT SALT PLAINS HEALTH CENTER, INC.
Other - Org Name:GSP HEALTH MEDFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-596-2800
Mailing Address - Street 1:405 S OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:OK
Mailing Address - Zip Code:73728-2545
Mailing Address - Country:US
Mailing Address - Phone:580-596-2800
Mailing Address - Fax:580-596-2805
Practice Address - Street 1:619 FRONT STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OK
Practice Address - Zip Code:73759-1209
Practice Address - Country:US
Practice Address - Phone:580-395-3200
Practice Address - Fax:580-596-2805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT SALT PLAINS HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-14
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty