Provider Demographics
NPI:1578716502
Name:WEATHERFORD HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:WEATHERFORD HOSPITAL AUTHORITY
Other - Org Name:WRH CLINIC LAB AND RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGANNA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-774-4762
Mailing Address - Street 1:3701 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-3309
Mailing Address - Country:US
Mailing Address - Phone:580-772-5551
Mailing Address - Fax:580-774-0964
Practice Address - Street 1:3733 LEGACY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-9746
Practice Address - Country:US
Practice Address - Phone:580-772-3816
Practice Address - Fax:580-772-3275
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEATHERFORD REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-04
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2219282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00370092001OtherBCBS
OK100698870EMedicaid
OK100699870CMedicaid
OK100699870CMedicaid
OK100698870EMedicaid
OK37-Z323Medicare PIN
OK1285709998Medicare UPIN