Provider Demographics
NPI:1275865982
Name:PAULS VALLEY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:PAULS VALLEY GENERAL HOSPITAL
Other - Org Name:PAULS VALLEY PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE EXEC
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:CHAPMAN
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-238-5501
Mailing Address - Street 1:100 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-6613
Mailing Address - Country:US
Mailing Address - Phone:405-238-5501
Mailing Address - Fax:405-238-5396
Practice Address - Street 1:100 VALLEY DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075
Practice Address - Country:US
Practice Address - Phone:405-238-5501
Practice Address - Fax:405-238-5396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAULS VALLEY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-04
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR40858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200276050AMedicaid
OKP37015601OtherMEDICARE PTAN