Provider Demographics
NPI:1891871885
Name:HOLDENVILLE GENERAL HOSPITAL SCHOLARSHIP FUND INC
Entity Type:Organization
Organization Name:HOLDENVILLE GENERAL HOSPITAL SCHOLARSHIP FUND INC
Other - Org Name:ALLEN HEALTH CLINIC
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 1:202 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:OK
Mailing Address - Zip Code:74825-0350
Mailing Address - Country:US
Mailing Address - Phone:580-857-2424
Mailing Address - Fax:580-857-2220
Practice Address - Street 1:202 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:OK
Practice Address - Zip Code:74825-0350
Practice Address - Country:US
Practice Address - Phone:580-857-2424
Practice Address - Fax:580-857-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2195261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699880BMedicaid
OKH37015401Medicare PIN