Provider Demographics
NPI:1982723870
Name:OKMULGEE WOMEN'S HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:OKMULGEE WOMEN'S HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:HUCKEBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-2229
Mailing Address - Street 1:1101 S BELMONT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6315
Mailing Address - Country:US
Mailing Address - Phone:918-756-2229
Mailing Address - Fax:918-756-2239
Practice Address - Street 1:1101 S BELMONT AVE STE 105
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6315
Practice Address - Country:US
Practice Address - Phone:918-756-2229
Practice Address - Fax:918-756-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF38731Medicare UPIN