Provider Demographics
NPI:1295858983
Name:HASKELL COUNTY - CITY OF STIGLER HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:HASKELL COUNTY - CITY OF STIGLER HOSPITAL AUTHORITY
Other - Org Name:STIGLER RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-4682
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0728
Mailing Address - Country:US
Mailing Address - Phone:918-967-8814
Mailing Address - Fax:918-967-8894
Practice Address - Street 1:901 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1617
Practice Address - Country:US
Practice Address - Phone:918-967-8814
Practice Address - Fax:918-967-8894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HASKELL COUNTY HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7164261QM2500X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700850HMedicaid
OK100700850CMedicaid
OK500522130Medicare PIN