1588686679 NPI number — MAYES COUNTY HMA, LLC

Table of content: (NPI 1588686679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588686679 NPI number — MAYES COUNTY HMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYES COUNTY HMA, 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:
ALLIANCEHEALTH PRYOR
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:
1588686679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N BAILEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRYOR
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74361-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-825-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N BAILEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRYOR
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74361-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-825-1600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  2183 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 2183 , 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: 100700040E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100784710A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200001840C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200017970A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00216948 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100118840A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 241407503 . This is a "MEDICARE PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100096890A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100195450C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24M802409 . This is a "MEDICARE PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100133830B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: G001501005 . This is a "MEDICARE PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100700040A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200114640A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 241400717 . This is a "MEDICARE PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 249404202 . This is a "MEDICARE PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100204600A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100252290A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: G001501039 . This is a "MEDICARE PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00121324 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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