Provider Demographics
NPI:1851537096
Name:PRAGUE HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:PRAGUE HEALTHCARE AUTHORITY
Other - Org Name:PRAGUE MEMORIAL REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-567-4922
Mailing Address - Street 1:1322 KLABZUBA AVE
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-4900
Mailing Address - Country:US
Mailing Address - Phone:405-567-4922
Mailing Address - Fax:405-567-4290
Practice Address - Street 1:1322 KLABZUBA AVENUE
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864
Practice Address - Country:US
Practice Address - Phone:405-567-4922
Practice Address - Fax:405-567-4290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAGUE HEALTHCARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-17
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X
OK2164282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200231400AMedicaid
OKOKA100954Medicare Oscar/Certification