Provider Demographics
NPI:1508828625
Name:PAULS VALLEY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:PAULS VALLEY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MYNHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-238-5501
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-6613
Mailing Address - Country:US
Mailing Address - Phone:405-238-5501
Mailing Address - Fax:405-238-5926
Practice Address - Street 1:100 VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-6613
Practice Address - Country:US
Practice Address - Phone:405-238-5501
Practice Address - Fax:405-238-5926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAULS VALLEY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-04
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2288275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37U156Medicare Oscar/Certification