Provider Demographics
NPI:1043959141
Name:SEQUOYAH COUNTY-CITY OF SALLISAW HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:SEQUOYAH COUNTY-CITY OF SALLISAW HOSPITAL AUTHORITY
Other - Org Name:NORTHEASTERN HEALTH SYSTEM SEQUOYAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-774-1100
Mailing Address - Street 1:213 E REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2811
Mailing Address - Country:US
Mailing Address - Phone:191-877-4111
Mailing Address - Fax:
Practice Address - Street 1:511 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-3020
Practice Address - Country:US
Practice Address - Phone:918-775-1619
Practice Address - Fax:918-775-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty