Provider Demographics
NPI:1306203187
Name:MCALESTER REGIONAL HEALTH CENTER AUTHORITY
Entity Type:Organization
Organization Name:MCALESTER REGIONAL HEALTH CENTER AUTHORITY
Other - Org Name:SOUTHEAST HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-426-1800
Mailing Address - Street 1:1308 E CARL ALBERT PKWY
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5130
Mailing Address - Country:US
Mailing Address - Phone:918-421-8018
Mailing Address - Fax:918-421-8620
Practice Address - Street 1:1308 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5130
Practice Address - Country:US
Practice Address - Phone:918-421-8018
Practice Address - Fax:918-421-8620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCALESTER REGIONAL HEALTH CENTER AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377090Medicare Oscar/Certification