Provider Demographics
NPI:1205858065
Name:LEFLORE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:LEFLORE COUNTY HOSPITAL AUTHORITY
Other - Org Name:EASTERN OKLAHOMA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-635-3300
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1148
Mailing Address - Country:US
Mailing Address - Phone:918-647-8233
Mailing Address - Fax:918-635-3468
Practice Address - Street 1:105 WALL STREET
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953
Practice Address - Country:US
Practice Address - Phone:918-647-8233
Practice Address - Fax:918-635-3468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK377060251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377060Medicare ID - Type Unspecified