Provider Demographics
NPI:1417099409
Name:MUSKOGEE REGIONAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MUSKOGEE REGIONAL MEDICAL CENTER LLC
Other - Org Name:MUSKOGEE REG MED CTR HOME HEALTH SER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLIPKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-764-3000
Mailing Address - Street 1:300 ROCKEFELLER DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5075
Mailing Address - Country:US
Mailing Address - Phone:918-682-5501
Mailing Address - Fax:918-684-2552
Practice Address - Street 1:300 ROCKEFELLER DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5075
Practice Address - Country:US
Practice Address - Phone:918-682-5501
Practice Address - Fax:918-684-2552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSKOGEE REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2177251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700630BMedicaid
OK377096Medicare PIN