Provider Demographics
NPI:1972000628
Name:OKLAHOMA DEPARTMENT OF VETERANS NORMAN CENTER
Entity Type:Organization
Organization Name:OKLAHOMA DEPARTMENT OF VETERANS NORMAN CENTER
Other - Org Name:ARDMORE VETERANS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-523-4000
Mailing Address - Street 1:1015 S COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5018
Mailing Address - Country:US
Mailing Address - Phone:580-223-2266
Mailing Address - Fax:580-223-2266
Practice Address - Street 1:1015 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5018
Practice Address - Country:US
Practice Address - Phone:580-223-2266
Practice Address - Fax:580-223-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK12-25343336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175900OtherPK