Provider Demographics
NPI:1578555777
Name:WATONGA HOSPITAL TRUST AUTHORITY
Entity Type:Organization
Organization Name:WATONGA HOSPITAL TRUST AUTHORITY
Other - Org Name:WATONGA MUNICIPAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOYEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-623-7211
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-0370
Mailing Address - Country:US
Mailing Address - Phone:580-623-7211
Mailing Address - Fax:580-623-7206
Practice Address - Street 1:500 N CLARENCE NASH BLVD
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-2845
Practice Address - Country:US
Practice Address - Phone:580-623-7211
Practice Address - Fax:580-623-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2214282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371302Medicare ID - Type Unspecified