Provider Demographics
NPI:1679664080
Name:ARDMORE INSTITUTE OF HEALTH
Entity type:Organization
Organization Name:ARDMORE INSTITUTE OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-993-2327
Mailing Address - Street 1:RR 1 BOX 4001
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-9796
Mailing Address - Country:US
Mailing Address - Phone:580-993-2327
Mailing Address - Fax:580-993-3902
Practice Address - Street 1:RR 1 BOX 4001
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-9796
Practice Address - Country:US
Practice Address - Phone:580-993-2327
Practice Address - Fax:580-993-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center