Provider Demographics
NPI:1689062705
Name:WEATHERFORD HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:WEATHERFORD HOSPITAL AUTHORITY
Other - Org Name:WRH ENT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-772-5551
Mailing Address - Street 1:3701 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-3309
Mailing Address - Country:US
Mailing Address - Phone:580-772-5551
Mailing Address - Fax:580-774-2314
Practice Address - Street 1:3739 LEGACY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-9746
Practice Address - Country:US
Practice Address - Phone:580-772-2268
Practice Address - Fax:580-772-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23518207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00370092001OtherBCBS
OK10699870CMedicaid
OK10698870EMedicaid
OK1639175185Medicare UPIN
OK10699870CMedicaid
OK00370092001OtherBCBS
OK10698870EMedicaid