Provider Demographics
NPI:1609355312
Name:BLACKWELL HOSPITAL TRUST AUTHORITY
Entity Type:Organization
Organization Name:BLACKWELL HOSPITAL TRUST AUTHORITY
Other - Org Name:BLACKWELL HOSPITAL PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-363-2311
Mailing Address - Street 1:PO BOX 720402
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4296
Mailing Address - Country:US
Mailing Address - Phone:580-363-2311
Mailing Address - Fax:
Practice Address - Street 1:706 S 13TH ST STE C
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-3705
Practice Address - Country:US
Practice Address - Phone:580-363-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty