Provider Demographics
NPI:1932477288
Name:US PHS FEDERAL BUREAU OF PRISONS
Entity Type:Organization
Organization Name:US PHS FEDERAL BUREAU OF PRISONS
Other - Org Name:FCI, EL RENO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IOP/IDC COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-319-7655
Mailing Address - Street 1:4205 W US HIGHWAY 66
Mailing Address - Street 2:PO BOX 1000
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-6906
Mailing Address - Country:US
Mailing Address - Phone:405-319-7655
Mailing Address - Fax:
Practice Address - Street 1:4205 W US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-6906
Practice Address - Country:US
Practice Address - Phone:405-319-7655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health