Provider Demographics
NPI:1740967785
Name:GREAT SALT PLAINS HEALTH CENTER, INC.
Entity type:Organization
Organization Name:GREAT SALT PLAINS HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-215-1766
Mailing Address - Street 1:205 W MAPLE AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4047
Mailing Address - Country:US
Mailing Address - Phone:580-596-2800
Mailing Address - Fax:580-596-2805
Practice Address - Street 1:5320 W CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703
Practice Address - Country:US
Practice Address - Phone:580-233-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT SALT PLAINS HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)