Provider Demographics
NPI:1619070760
Name:PREFERRED HOSPITAL LEASING VAN HORN
Entity Type:Organization
Organization Name:PREFERRED HOSPITAL LEASING VAN HORN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-878-0202
Mailing Address - Street 1:120 W MACARTHUR ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2028
Mailing Address - Country:US
Mailing Address - Phone:405-878-0202
Mailing Address - Fax:405-273-6007
Practice Address - Street 1:EISENHOWER RD & FM 2185
Practice Address - Street 2:
Practice Address - City:VAN HORN
Practice Address - State:TX
Practice Address - Zip Code:79855
Practice Address - Country:US
Practice Address - Phone:432-283-2760
Practice Address - Fax:432-283-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008172275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-Z338Medicare Oscar/Certification