Provider Demographics
NPI:1114421492
Name:FARMERS UNION HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:FARMERS UNION HOSPITAL ASSOCIATION
Other - Org Name:GREAT PLAINS PAT WALL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-821-5300
Mailing Address - Street 1:PO BOX 2339
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-2339
Mailing Address - Country:US
Mailing Address - Phone:580-225-2511
Mailing Address - Fax:580-225-9143
Practice Address - Street 1:1800 W 1ST ST
Practice Address - Street 2:SUITES 101, 102, 103 AND 105
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3133
Practice Address - Country:US
Practice Address - Phone:580-225-2515
Practice Address - Fax:580-303-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health