1174701080 NPI number — RHA TISHOMINGO LLC

Table of content: (NPI 1174701080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174701080 NPI number — RHA TISHOMINGO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHA TISHOMINGO 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:
JOHNSTON MEMORIAL 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:
1174701080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12932
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73157-2932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-917-0300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 SOUTH BYRD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TISHOMINGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73460-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-371-2327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUSTER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-917-0300

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  2283 , 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)





Copyright © 2007-2024 www.npivalidator.com