Provider Demographics
NPI:1184168643
Name:OKLAHOMA STATE DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:OKLAHOMA STATE DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLES-BOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:405-271-4476
Mailing Address - Street 1:1000 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1207
Mailing Address - Country:US
Mailing Address - Phone:405-271-4476
Mailing Address - Fax:
Practice Address - Street 1:1000 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1207
Practice Address - Country:US
Practice Address - Phone:405-271-4476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK120947261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility