Provider Demographics
NPI:1538155163
Name:MORTON COMPREHENSIVE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:MORTON COMPREHENSIVE HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAUNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-295-6107
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-587-2171
Mailing Address - Fax:918-273-9946
Practice Address - Street 1:207 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-3660
Practice Address - Country:US
Practice Address - Phone:918-273-9911
Practice Address - Fax:918-273-9946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORTON COMPREHENSIVE HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-20
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1538155163OtherNPI
OK100768880JMedicaid
OKWCDPGOtherMEDICARE
OK100768880JMedicaid
OK100850700BMedicaid
OK371832Medicare Oscar/Certification