Provider Demographics
NPI:1003873811
Name:CLAREMORE REGIONAL HOSPITAL LLC
Entity Type:Organization
Organization Name:CLAREMORE REGIONAL HOSPITAL LLC
Other - Org Name:CLAREMORE REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 848457
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8457
Mailing Address - Country:US
Mailing Address - Phone:918-342-6705
Mailing Address - Fax:918-342-3330
Practice Address - Street 1:1202 N MUSKOGEE PL
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3058
Practice Address - Country:US
Practice Address - Phone:918-342-6705
Practice Address - Fax:918-342-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
OK2192282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
370039Medicare Oscar/Certification