Provider Demographics
NPI:1346344330
Name:MCALESTER REGIONAL HEALTH CENTER AUTHORITY
Entity Type:Organization
Organization Name:MCALESTER REGIONAL HEALTH CENTER AUTHORITY
Other - Org Name:MCALESTER REGIONAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-421-8019
Mailing Address - Street 1:1 E CLARK BASS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4209
Mailing Address - Country:US
Mailing Address - Phone:918-421-8018
Mailing Address - Fax:918-421-8620
Practice Address - Street 1:1101 N STRONG BLVD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4263
Practice Address - Country:US
Practice Address - Phone:918-421-8018
Practice Address - Fax:918-421-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7132251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000377090001OtherBLUE CROSS PROVIDER NUMBE
OK100260660AMedicaid
OK100260660AMedicaid
OK377090Medicare Oscar/Certification