Provider Demographics
NPI:1639877871
Name:COAL COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:COAL COUNTY GENERAL HOSPITAL
Other - Org Name:EASTERN OKLAHOMA HEALTH CLINIC OF ATOKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-927-2327
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:COALGATE
Mailing Address - State:OK
Mailing Address - Zip Code:74538-0326
Mailing Address - Country:US
Mailing Address - Phone:580-927-2327
Mailing Address - Fax:580-927-2439
Practice Address - Street 1:1668 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-1703
Practice Address - Country:US
Practice Address - Phone:580-889-3355
Practice Address - Fax:580-889-5272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COAL COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-17
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774650HMedicaid