Provider Demographics
NPI:1528225588
Name:EASTERN OKLAHOMA MEDICAL CENTER
Entity Type:Organization
Organization Name:EASTERN OKLAHOMA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HOEGH
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PT
Authorized Official - Phone:918-635-3178
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1148
Mailing Address - Country:US
Mailing Address - Phone:918-635-3178
Mailing Address - Fax:918-635-3194
Practice Address - Street 1:105 WALL ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4433
Practice Address - Country:US
Practice Address - Phone:918-635-3178
Practice Address - Fax:918-635-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1627282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital