Provider Demographics
NPI:1013133420
Name:PRAGUE HEALTHCARE ALLIANCE INC
Entity type:Organization
Organization Name:PRAGUE HEALTHCARE ALLIANCE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-567-4922
Mailing Address - Street 1:PO BOX S
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-1090
Mailing Address - Country:US
Mailing Address - Phone:405-567-4922
Mailing Address - Fax:405-567-4290
Practice Address - Street 1:1322 KLABZUBA
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 ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty