Provider Demographics
NPI:1053447086
Name:JANE PHILLIPS NOWATA HEALTH CENTER
Entity Type:Organization
Organization Name:JANE PHILLIPS NOWATA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-273-3102
Mailing Address - Street 1:237 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-3660
Mailing Address - Country:US
Mailing Address - Phone:918-331-5413
Mailing Address - Fax:
Practice Address - Street 1:237 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-3660
Practice Address - Country:US
Practice Address - Phone:918-331-5413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANE PHILLIPS NOWATA HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2187282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37Z305Medicare Oscar/Certification