Provider Demographics
NPI:1376712695
Name:SEQUOYAH COUNTY CITY OF SALLISAW HOPSITAL AUTHORITY
Entity Type:Organization
Organization Name:SEQUOYAH COUNTY CITY OF SALLISAW HOPSITAL AUTHORITY
Other - Org Name:SEQUOYAH MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-774-1100
Mailing Address - Street 1:213 E REDWOOD AVE
Mailing Address - Street 2:PO BOX 505
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2811
Mailing Address - Country:US
Mailing Address - Phone:918-774-1100
Mailing Address - Fax:
Practice Address - Street 1:213 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2811
Practice Address - Country:US
Practice Address - Phone:918-774-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4028251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700190OMedicaid