Provider Demographics
NPI:1346494275
Name:WEATHERFORD HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:WEATHERFORD HOSPITAL AUTHORITY
Other - Org Name:WEATHERFORD REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGANNA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-774-4762
Mailing Address - Street 1:215 N KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5443
Mailing Address - Country:US
Mailing Address - Phone:580-772-5551
Mailing Address - Fax:580-774-2314
Practice Address - Street 1:3701 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-3309
Practice Address - Country:US
Practice Address - Phone:580-772-5551
Practice Address - Fax:580-774-2314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEATHERFORD REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-05
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2219282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100698870EMedicaid
OK00370092001OtherBCBS
OK100699870CMedicaid
OK37-Z323Medicare PIN
OK00370092001OtherBCBS
OK1578716502Medicare UPIN
OK1639175185Medicare UPIN
OK1285709998Medicare PIN