Provider Demographics
NPI:1144212556
Name:PUSHMATAHA COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:PUSHMATAHA COUNTY HOSPITAL AUTHORITY
Other - Org Name:PUSHMATAHA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-298-3341
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0518
Mailing Address - Country:US
Mailing Address - Phone:580-298-3341
Mailing Address - Fax:580-298-4713
Practice Address - Street 1:510 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-3262
Practice Address - Country:US
Practice Address - Phone:580-298-3341
Practice Address - Fax:580-298-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2199282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000373983001OtherBCBS PRHC
OK000370083001OtherBCBS PUSHMATAHA HOSPITAL
OK100700770Medicaid
OK370083Medicare Oscar/Certification
OK000373983001OtherBCBS PRHC