Provider Demographics
NPI:1265578306
Name:DR ELOISE J HAYES PLLC
Entity type:Organization
Organization Name:DR ELOISE J HAYES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-225-3999
Mailing Address - Street 1:1800 W 1ST ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-3133
Mailing Address - Country:US
Mailing Address - Phone:580-225-3999
Mailing Address - Fax:580-225-3979
Practice Address - Street 1:1800 W 1ST ST
Practice Address - Street 2:SUITE 109
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3133
Practice Address - Country:US
Practice Address - Phone:580-225-3999
Practice Address - Fax:580-225-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDF7379OtherRAILROAD MEDICARE
OK=========-001OtherBCBS OF OKLAHOMA