Provider Demographics
NPI:1295778231
Name:CRAIG COUNTY HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:CRAIG COUNTY HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:WALK
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:918-256-7551
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0326
Mailing Address - Country:US
Mailing Address - Phone:918-256-7551
Mailing Address - Fax:918-256-7395
Practice Address - Street 1:735 N FOREMAN ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1422
Practice Address - Country:US
Practice Address - Phone:918-256-7551
Practice Address - Fax:918-256-7395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAIG COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7139251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100261400AMedicaid
OK377149Medicare Oscar/Certification