Provider Demographics
NPI:1871960195
Name:COORDINATED CARE HEALTH SOLUTIONS, LLC
Entity type:Organization
Organization Name:COORDINATED CARE HEALTH SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AM
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-2929
Mailing Address - Street 1:PO BOX 108835
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8835
Mailing Address - Country:US
Mailing Address - Phone:405-605-0720
Mailing Address - Fax:405-730-8047
Practice Address - Street 1:10120 BROADWAY EXT STE 220
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6300
Practice Address - Country:US
Practice Address - Phone:405-605-0720
Practice Address - Fax:405-463-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1871960195291U00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1871960195Medicaid
1871960195OtherNPI
NE10026596800Medicaid
OK200622830 AMedicaid
AR212247709Medicaid
TX367240401Medicaid
OK37D2093763OtherCLIA
26303OtherCOLA