Provider Demographics
NPI:1467577015
Name:FARMERS UNION HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:FARMERS UNION HOSPITAL ASSOCIATION
Other - Org Name:GREAT PLAINS REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:IKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-225-2511
Mailing Address - Street 1:PO BOX 2339
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-2339
Mailing Address - Country:US
Mailing Address - Phone:580-225-2511
Mailing Address - Fax:580-821-5524
Practice Address - Street 1:1801 W. 3RD STREET
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4455
Practice Address - Country:US
Practice Address - Phone:580-225-2511
Practice Address - Fax:580-821-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
OK261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699410CMedicaid