Provider Demographics
NPI:1700268844
Name:COMMUNITY HEALTH CONNECTION, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH CONNECTION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-710-4413
Mailing Address - Street 1:2321 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-1831
Mailing Address - Country:US
Mailing Address - Phone:918-710-4400
Mailing Address - Fax:918-710-4401
Practice Address - Street 1:2321 E 3RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-1831
Practice Address - Country:US
Practice Address - Phone:918-710-4400
Practice Address - Fax:918-710-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK272993336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152555OtherPK