Provider Demographics
NPI:1073683298
Name:HOLDENVILLE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:HOLDENVILLE GENERAL HOSPITAL
Other - Org Name:WETUMKA RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:COSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-379-4200
Mailing Address - Street 1:100 MCDOUGAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848
Mailing Address - Country:US
Mailing Address - Phone:405-379-4200
Mailing Address - Fax:405-379-4238
Practice Address - Street 1:401 S WASHITA ST
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883-5524
Practice Address - Country:US
Practice Address - Phone:405-452-5558
Practice Address - Fax:405-452-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2195261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK373460Medicare ID - Type Unspecified