Provider Demographics
NPI:1285626424
Name:RURAL HEALTHCARE OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:RURAL HEALTHCARE OF OKLAHOMA, INC
Other - Org Name:LANE FROST HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-626-2751
Mailing Address - Street 1:2815 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4250
Mailing Address - Country:US
Mailing Address - Phone:580-326-9200
Mailing Address - Fax:580-317-2810
Practice Address - Street 1:2815 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4250
Practice Address - Country:US
Practice Address - Phone:580-326-9200
Practice Address - Fax:580-317-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2353282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200042180AMedicaid
OK900522227Medicare ID - Type UnspecifiedGROUP NUMBER
OK200042180AMedicaid