Provider Demographics
NPI:1821159922
Name:PATHWAYS OF OKLAHOMA INC
Entity Type:Organization
Organization Name:PATHWAYS OF OKLAHOMA INC
Other - Org Name:PROVIDENCE OF OKLAHOMA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTRACT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-570-1460
Mailing Address - Street 1:1161 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4607
Mailing Address - Country:US
Mailing Address - Phone:520-570-1460
Mailing Address - Fax:520-745-0638
Practice Address - Street 1:134 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4718
Practice Address - Country:US
Practice Address - Phone:580-924-6363
Practice Address - Fax:580-924-0379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100750190AMedicaid
OK100750190AMedicaid