1881689289 NPI number — CHOCTAW COUNTY CITY OF HUGO HOSPITAL AUTHORITY

Table of content: (NPI 1881689289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881689289 NPI number — CHOCTAW COUNTY CITY OF HUGO HOSPITAL AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOCTAW COUNTY CITY OF HUGO HOSPITAL 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:
CHOCTAW 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:
1881689289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 E. KIRK ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUGO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74743-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-317-9500
Provider Business Mailing Address Fax Number:
580-326-3541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 E KIRK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74743-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-317-9500
Provider Business Practice Location Address Fax Number:
580-326-3541
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROWLAND
Authorized Official First Name:
NICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
580-317-9500

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2191 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NR1301X , with the licence number: 2191 , 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: DD0940 . This is a "MEDICARE RAILROAD UPIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100700720A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000370100001 . This is a "BCBS OF OK" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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