Provider Demographics
NPI:1821410648
Name:COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC.
Other - Org Name:ROUTE 66 HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-257-8029
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:OK
Mailing Address - Zip Code:74331-0705
Mailing Address - Country:US
Mailing Address - Phone:918-257-8029
Mailing Address - Fax:918-257-8042
Practice Address - Street 1:138 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:OK
Practice Address - Zip Code:74331-0000
Practice Address - Country:US
Practice Address - Phone:918-257-8029
Practice Address - Fax:918-257-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)