Provider Demographics
NPI:1972539567
Name:SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Other - Org Name:SEQUOYAH MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-774-1100
Mailing Address - Street 1:213 E REDWOOD
Mailing Address - Street 2:PO BOX 505
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2811
Mailing Address - Country:US
Mailing Address - Phone:918-774-1100
Mailing Address - Fax:918-774-1142
Practice Address - Street 1:213 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2811
Practice Address - Country:US
Practice Address - Phone:918-774-1100
Practice Address - Fax:918-774-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2189282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
370112Medicare Oscar/Certification