Provider Demographics
NPI:1568615656
Name:MERCY HOSPITAL HEALDTON, INC
Entity Type:Organization
Organization Name:MERCY HOSPITAL HEALDTON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ENLOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-752-3161
Mailing Address - Street 1:4300 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8304
Mailing Address - Country:US
Mailing Address - Phone:405-752-3724
Mailing Address - Fax:
Practice Address - Street 1:3462 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-6124
Practice Address - Country:US
Practice Address - Phone:580-229-0701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2346282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access