Provider Demographics
NPI:1598039620
Name:CAH ACQUISITION COMPANY 12 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 12 LLC
Other - Org Name:THE PAWNEE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-642-3291
Mailing Address - Street 1:40 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:OK
Mailing Address - Zip Code:74637-5084
Mailing Address - Country:US
Mailing Address - Phone:918-642-3291
Mailing Address - Fax:918-642-3694
Practice Address - Street 1:535 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058
Practice Address - Country:US
Practice Address - Phone:918-762-3942
Practice Address - Fax:918-762-4675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAH ACQUISITION COMPANY 12 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-07
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2274261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200311270EMedicaid
OK200311270EMedicaid