Provider Demographics
NPI:1205876752
Name:RURAL HEALTH CARE INNOVATIONS
Entity type:Organization
Organization Name:RURAL HEALTH CARE INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-857-1300
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:OK
Mailing Address - Zip Code:74825-0250
Mailing Address - Country:US
Mailing Address - Phone:580-857-1300
Mailing Address - Fax:580-857-1302
Practice Address - Street 1:200 N EASTON
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:OK
Practice Address - Zip Code:74825-0250
Practice Address - Country:US
Practice Address - Phone:580-857-1300
Practice Address - Fax:580-857-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200022320AMedicaid
OK100113870DMedicaid
OK200022320AMedicaid
OKI20300Medicare UPIN
OK100113870DMedicaid