Provider Demographics
NPI:1093983520
Name:WEATHERFORD HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:WEATHERFORD HOSPITAL AUTHORITY
Other - Org Name:WEATHERFORD REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:580-772-5551
Mailing Address - Street 1:3701 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-3309
Mailing Address - Country:US
Mailing Address - Phone:580-772-5551
Mailing Address - Fax:580-774-0964
Practice Address - Street 1:3701 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-3309
Practice Address - Country:US
Practice Address - Phone:580-772-5551
Practice Address - Fax:580-774-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2219146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699870CMedicaid