Provider Demographics
NPI:1578026571
Name:LEFLORE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:LEFLORE COUNTY HOSPITAL AUTHORITY
Other - Org Name:CAVANAL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-635-3441
Mailing Address - Street 1:1013 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4409
Mailing Address - Country:US
Mailing Address - Phone:918-647-2929
Mailing Address - Fax:918-647-2288
Practice Address - Street 1:1013 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4409
Practice Address - Country:US
Practice Address - Phone:918-647-2929
Practice Address - Fax:918-647-2288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEFLORE COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-08
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK513012Medicaid