1003873811 NPI number — CLAREMORE REGIONAL HOSPITAL LLC

Table of content: (NPI 1003873811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003873811 NPI number — CLAREMORE REGIONAL HOSPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAREMORE REGIONAL HOSPITAL LLC
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:
CLAREMORE REGIONAL HOSPITAL
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:
1003873811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-8457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-342-6705
Provider Business Mailing Address Fax Number:
918-342-3330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1202 N MUSKOGEE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74017-3058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-342-6705
Provider Business Practice Location Address Fax Number:
918-342-3330
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, BUSINESS OFFICE SERVICES
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 2192 , 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)





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