Provider Demographics
NPI:1447561584
Name:CAH ACQUISITION COMPANY 16 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 16 LLC
Other - Org Name:SPECIALTY CLINIC OF STIGLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-4682
Mailing Address - Street 1:401 NW H STREET
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1625
Mailing Address - Country:US
Mailing Address - Phone:918-967-4682
Mailing Address - Fax:918-967-2332
Practice Address - Street 1:901 NW 6TH STREET
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462
Practice Address - Country:US
Practice Address - Phone:918-967-5036
Practice Address - Fax:918-967-8462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAH ACQUISITION COMPANY 16 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-23
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200313370CMedicaid
OKOKA103328Medicare Oscar/Certification