Provider Demographics
NPI:1700090040
Name:MUSKOGEE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MUSKOGEE REGIONAL MEDICAL CENTER
Other - Org Name:MUSKOGEE IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLIPKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-764-3000
Mailing Address - Street 1:501 CORPORATE CENTRE DR.
Mailing Address - Street 2:STE. 200
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-764-3000
Mailing Address - Fax:615-764-3030
Practice Address - Street 1:3520 CHANDLER RD.
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4910
Practice Address - Country:US
Practice Address - Phone:918-682-0721
Practice Address - Fax:918-683-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty