Provider Demographics
NPI:1851479166
Name:HOLDENVILLE GENERAL HOSPITAL SCHOLARSHIP FUND INC
Entity Type:Organization
Organization Name:HOLDENVILLE GENERAL HOSPITAL SCHOLARSHIP FUND INC
Other - Org Name:HOLDENVILLE GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:405-379-4200
Mailing Address - Street 1:100 MCDOUGAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-2822
Mailing Address - Country:US
Mailing Address - Phone:405-379-4200
Mailing Address - Fax:405-379-4284
Practice Address - Street 1:100 MCDOUGAL DR
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-2822
Practice Address - Country:US
Practice Address - Phone:405-379-4200
Practice Address - Fax:405-379-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
OK2195275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10069988AMedicaid
OK37Z321Medicare Oscar/Certification