Provider Demographics
NPI:1851460745
Name:SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-564-1660
Mailing Address - Street 1:500 HWY 70 NORTH
Mailing Address - Street 2:P.O. BOX 1710
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439
Mailing Address - Country:US
Mailing Address - Phone:580-564-1660
Mailing Address - Fax:
Practice Address - Street 1:5912 US HWY 70
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:OK
Practice Address - Zip Code:73449
Practice Address - Country:US
Practice Address - Phone:580-745-9083
Practice Address - Fax:580-745-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)