Provider Demographics
NPI:1568472090
Name:HEALDTON MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:HEALDTON MUNICIPAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-229-0701
Mailing Address - Street 1:918 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-2424
Mailing Address - Country:US
Mailing Address - Phone:580-229-0701
Mailing Address - Fax:580-229-1454
Practice Address - Street 1:918 S 8TH ST
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-2424
Practice Address - Country:US
Practice Address - Phone:580-229-0701
Practice Address - Fax:580-229-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2346282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000373456001OtherOK BCBS 12 DIGIT #
OK=========OtherCHAMPUS/TRICARE #
OK371310Medicare Oscar/Certification