Provider Demographics
NPI:1881689289
Name:CHOCTAW COUNTY CITY OF HUGO HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CHOCTAW COUNTY CITY OF HUGO HOSPITAL AUTHORITY
Other - Org Name:CHOCTAW MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-317-9500
Mailing Address - Street 1:1405 E. KIRK ST.
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-3603
Mailing Address - Country:US
Mailing Address - Phone:580-317-9500
Mailing Address - Fax:580-326-3541
Practice Address - Street 1:1405 E KIRK ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3603
Practice Address - Country:US
Practice Address - Phone:580-317-9500
Practice Address - Fax:580-326-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2191282N00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDD0940OtherMEDICARE RAILROAD UPIN
OK100700720AMedicaid
OK000370100001OtherBCBS OF OK
OK000370100001OtherBCBS OF OK
370100Medicare UPIN