1336142033 NPI number — OKEENE MUNICIPAL HOSPITAL AND SCHALLMO AUTHORITY

Table of content: (NPI 1336142033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336142033 NPI number — OKEENE MUNICIPAL HOSPITAL AND SCHALLMO AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKEENE MUNICIPAL HOSPITAL AND SCHALLMO AUTHORITY
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:
OKEENE MUNICIPAL 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:
1336142033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 489
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKEENE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73763-0489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-822-4417
Provider Business Mailing Address Fax Number:
580-822-3018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 EAST F ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKEENE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73763-0489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-822-4417
Provider Business Practice Location Address Fax Number:
580-822-3018
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DUNHAM
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
ADMINISTRATOR CEO
Authorized Official Telephone Number:
580-822-4417

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  2224 , 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: 100700250A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100700250D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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