Provider Demographics
NPI:1457808669
Name:SGOH ACQUISITION, INC.
Entity Type:Organization
Organization Name:SGOH ACQUISITION, INC.
Other - Org Name:OCH JAY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:417-837-4090
Mailing Address - Street 1:2485 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-2201
Mailing Address - Country:US
Mailing Address - Phone:918-253-2550
Mailing Address - Fax:918-253-2122
Practice Address - Street 1:2485 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-2201
Practice Address - Country:US
Practice Address - Phone:918-253-2550
Practice Address - Fax:918-253-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health