Provider Demographics
NPI:1578587655
Name:PUSHMATAHA COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:PUSHMATAHA COUNTY HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR HOME HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALETT
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-298-5523
Mailing Address - Street 1:510 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-3262
Mailing Address - Country:US
Mailing Address - Phone:580-298-5523
Mailing Address - Fax:580-298-5545
Practice Address - Street 1:510 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-3262
Practice Address - Country:US
Practice Address - Phone:580-298-5523
Practice Address - Fax:580-298-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7049251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700770GMedicaid
OK100700770DMedicaid
OK100700770GMedicaid