Provider Demographics
NPI:1659316776
Name:MCALESTER REGIONAL HEALTH CENTER AUTHORITY
Entity Type:Organization
Organization Name:MCALESTER REGIONAL HEALTH CENTER AUTHORITY
Other - Org Name:MCALESTER REGIONAL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT/CEO
Authorized Official - Phone:918-421-8001
Mailing Address - Street 1:19 KIAMICHI ROAD
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432
Mailing Address - Country:US
Mailing Address - Phone:918-452-2330
Mailing Address - Fax:918-452-2335
Practice Address - Street 1:19 KIAMICHI ROAD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432
Practice Address - Country:US
Practice Address - Phone:918-452-2330
Practice Address - Fax:918-452-2335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCALESTER REGIONAL HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2203261QR1300X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100710530BMedicaid
OK100710530BMedicaid