Provider Demographics
NPI:1366525255
Name:FIVE STAR INTERLOCAL COOPERATIVE
Entity type:Organization
Organization Name:FIVE STAR INTERLOCAL COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-225-5600
Mailing Address - Street 1:1405 E MOSES ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-3635
Mailing Address - Country:US
Mailing Address - Phone:918-225-5600
Mailing Address - Fax:918-225-3026
Practice Address - Street 1:1405 E MOSES ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-3635
Practice Address - Country:US
Practice Address - Phone:918-225-5600
Practice Address - Fax:918-225-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare