Provider Demographics
NPI:1265975668
Name:THREE RIVERS HEALTH CENTER MUSKOGEE
Entity type:Organization
Organization Name:THREE RIVERS HEALTH CENTER MUSKOGEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:918-781-6500
Mailing Address - Street 1:1001 S 41ST ST E
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-6253
Mailing Address - Country:US
Mailing Address - Phone:918-781-6500
Mailing Address - Fax:918-686-8398
Practice Address - Street 1:1001 S 41ST ST E
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-6253
Practice Address - Country:US
Practice Address - Phone:918-781-6500
Practice Address - Fax:918-686-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0039734261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health