Provider Demographics
NPI:1750459756
Name:COAL COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:COAL COUNTY GENERAL HOSPITAL
Other - Org Name:MARY HURLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:A
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 1:6 N COVINGTON ST
Practice Address - Street 2:
Practice Address - City:COALGATE
Practice Address - State:OK
Practice Address - Zip Code:74538-2002
Practice Address - Country:US
Practice Address - Phone:580-927-2327
Practice Address - Fax:580-927-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2201261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774650CMedicaid
OK100522146Medicare ID - Type UnspecifiedPHYSCIANS GROUP NUMBER