Provider Demographics
NPI:1871108514
Name:POTEAU COMMUNITY CARE
Entity type:Organization
Organization Name:POTEAU COMMUNITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-564-2010
Mailing Address - Street 1:107 E DORA LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5518
Mailing Address - Country:US
Mailing Address - Phone:191-883-9969
Mailing Address - Fax:
Practice Address - Street 1:1301 S BROADWAY AVE STE 2
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5268
Practice Address - Country:US
Practice Address - Phone:918-564-2010
Practice Address - Fax:918-564-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health