Provider Demographics
NPI:1114174588
Name:MCALESTER REGIONAL HOSPITALIST
Entity Type:Organization
Organization Name:MCALESTER REGIONAL HOSPITALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP HR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-426-1800
Mailing Address - Street 1:1 E CLARK BASS BLVD
Mailing Address - Street 2:MARKETING BUILDING
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4209
Mailing Address - Country:US
Mailing Address - Phone:918-426-1800
Mailing Address - Fax:918-421-6824
Practice Address - Street 1:1 E CLARK BASS BLVD
Practice Address - Street 2:MARKETING BUILDING
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4209
Practice Address - Country:US
Practice Address - Phone:918-426-1800
Practice Address - Fax:918-421-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2203208000000X, 208600000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200213440AMedicaid
OKDP4386OtherRAILROAD MEDICARE
OKOKB5332Medicare PIN