Provider Demographics
NPI:1174650766
Name:PAWHUSKA HOSPITAL, INC.
Entity Type:Organization
Organization Name:PAWHUSKA HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-287-3232
Mailing Address - Street 1:1101 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-1901
Mailing Address - Country:US
Mailing Address - Phone:918-287-3232
Mailing Address - Fax:918-287-5161
Practice Address - Street 1:1101 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-1901
Practice Address - Country:US
Practice Address - Phone:918-287-3232
Practice Address - Fax:918-287-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2271282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100690120AMedicaid
OK200021730AMedicaid
OK100255950BMedicaid
OK100690120CMedicaid
OK1174521991OtherHOSPITAL NPI ACUTE CARE
OK100255660BMedicaid