Provider Demographics
NPI:1497057699
Name:CRAIG COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CRAIG COUNTY HOSPITAL AUTHORITY
Other - Org Name:WELCH FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:918-256-7551
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:OK
Mailing Address - Zip Code:74369-0059
Mailing Address - Country:US
Mailing Address - Phone:918-788-3919
Mailing Address - Fax:918-788-3914
Practice Address - Street 1:343 S. COMMERCIAL ST.
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:OK
Practice Address - Zip Code:74369-0000
Practice Address - Country:US
Practice Address - Phone:918-788-3919
Practice Address - Fax:918-788-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2182282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
373466Medicare PIN