| Organization Name: | CENTRAL OK FAMILY MED CTR |
| NPI Number: | 1720290539 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CASEY H ANSON (EXECUTIVE DIRECTOR) |
| Mailing Address: | Rt 1 Box 85a Prague |
| State: | OK US |
| Postal Code: | 74864 |
| Phone Number: | 4055670054 |
| Fax Number: | 4055670087 |
| NPI Enumeration Date: | 05/04/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |