Provider Demographics
NPI:1568584118
Name:JEFFERSON COUNTY HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:JEFFERSON COUNTY HEALTHCARE AUTHORITY
Other - Org Name:JEFFERSON COUNTY HOSPITAL SWING BEDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-228-2344
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:WAURIKA
Mailing Address - State:OK
Mailing Address - Zip Code:73573-0090
Mailing Address - Country:US
Mailing Address - Phone:580-228-2344
Mailing Address - Fax:580-228-3410
Practice Address - Street 1:U.S. HIGHWAYS 70 & 81
Practice Address - Street 2:
Practice Address - City:WAURIKA
Practice Address - State:OK
Practice Address - Zip Code:73573-0090
Practice Address - Country:US
Practice Address - Phone:580-228-2344
Practice Address - Fax:580-228-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2233282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37Z311Medicare Oscar/Certification