Provider Demographics
NPI:1851727754
Name:COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:CHCI SHAWNEE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:405-769-3301
Mailing Address - Street 1:P.O. BOX 30589
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-3589
Mailing Address - Country:US
Mailing Address - Phone:405-769-3301
Mailing Address - Fax:405-769-9685
Practice Address - Street 1:130 N BROADWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6939
Practice Address - Country:US
Practice Address - Phone:405-395-0399
Practice Address - Fax:405-395-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100709120NMedicaid