Provider Demographics
NPI:1205181112
Name:SEQUOYAH COUNTY-CITY OF SALLISAW HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:SEQUOYAH COUNTY-CITY OF SALLISAW HOSPITAL AUTHORITY
Other - Org Name:SMH PRIMARY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNOKE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:918-774-1100
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-0505
Mailing Address - Country:US
Mailing Address - Phone:918-790-3309
Mailing Address - Fax:918-775-0587
Practice Address - Street 1:409 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-3018
Practice Address - Country:US
Practice Address - Phone:918-790-3309
Practice Address - Fax:918-775-0587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2189261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK370112Medicare PIN