Provider Demographics
NPI:1356788954
Name:OKLAHOMA OTOLARYNGOLOGY HEARING CENTER
Entity type:Organization
Organization Name:OKLAHOMA OTOLARYNGOLOGY HEARING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-755-6651
Mailing Address - Street 1:PO BOX 960472
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0472
Mailing Address - Country:US
Mailing Address - Phone:405-755-6651
Mailing Address - Fax:405-755-2313
Practice Address - Street 1:3824 S BOULEVARD STE 160
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5780
Practice Address - Country:US
Practice Address - Phone:405-562-1810
Practice Address - Fax:405-562-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty