Provider Demographics
NPI:1144698036
Name:TEXOMA RURAL HEALTH CENTER
Entity type:Organization
Organization Name:TEXOMA RURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-745-9535
Mailing Address - Street 1:127 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-4700
Mailing Address - Country:US
Mailing Address - Phone:580-745-9535
Mailing Address - Fax:580-745-9891
Practice Address - Street 1:508 E 24TH ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-3214
Practice Address - Country:US
Practice Address - Phone:580-371-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN OKLAHOMA FAMILY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty