1467577015 NPI number — FARMERS UNION HOSPITAL ASSOCIATION

Table of content: (NPI 1467577015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467577015 NPI number — FARMERS UNION HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMERS UNION HOSPITAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GREAT PLAINS REGIONAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467577015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73648-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-225-2511
Provider Business Mailing Address Fax Number:
580-821-5524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 W. 3RD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73644-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-225-2511
Provider Business Practice Location Address Fax Number:
580-821-5524
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IKNER
Authorized Official First Name:
ROY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
580-225-2511

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100699410C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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