Provider Demographics
NPI:1659498152
Name:HASKELL COUNTY HOSPITAL FOUNDATION
Entity Type:Organization
Organization Name:HASKELL COUNTY HOSPITAL FOUNDATION
Other - Org Name:STIGLER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-4682
Mailing Address - Street 1:905 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1611
Mailing Address - Country:US
Mailing Address - Phone:918-967-0072
Mailing Address - Fax:918-967-5040
Practice Address - Street 1:905 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1611
Practice Address - Country:US
Practice Address - Phone:918-967-0072
Practice Address - Fax:918-967-5040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HASKELL COUNTY-CITY OF STIGLER HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RI0200X
OK261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744050BMedicaid
OK100744050AMedicaid
OK100744050CMedicaid
OK200036010AMedicaid
OK200036010AMedicaid
OK600522426Medicare PIN