Basic Information
| Provider Information | |||||||||
| NPI: | 1184137804 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN PLAINS MEDICAL CENTER, INC | ||||||||
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| OtherOrganizationName: | MAYSVILLE HEALTH APRN-CNP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 W IOWA AVE | ||||||||
| Address2: | |||||||||
| City: | CHICKASHA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730182738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052248111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 504 WILLIAMS | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730573679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802475936 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2017 | ||||||||
| LastUpdateDate: | 01/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | LACEFIELD | ||||||||
| AuthorizedOfficialFirstName: | LEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4054546058 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 108875 | OK | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.