Provider Demographics
NPI:1740376086
Name:SOUTHEASTERN WOMEN'S HEALTH CENTER
Entity type:Organization
Organization Name:SOUTHEASTERN WOMEN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIEGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-332-8855
Mailing Address - Street 1:807 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-7711
Mailing Address - Country:US
Mailing Address - Phone:580-332-8855
Mailing Address - Fax:580-332-7374
Practice Address - Street 1:807 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-7711
Practice Address - Country:US
Practice Address - Phone:580-332-8855
Practice Address - Fax:580-332-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17253207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty