Provider Demographics
NPI:1750091500
Name:COAL COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:COAL COUNTY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-927-2327
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:COALGATE
Mailing Address - State:OK
Mailing Address - Zip Code:74538-0326
Mailing Address - Country:US
Mailing Address - Phone:580-927-2334
Mailing Address - Fax:580-927-9941
Practice Address - Street 1:108 W OHIO AVE
Practice Address - Street 2:
Practice Address - City:COALGATE
Practice Address - State:OK
Practice Address - Zip Code:74538-2827
Practice Address - Country:US
Practice Address - Phone:580-927-2337
Practice Address - Fax:580-927-9941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COAL COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-02
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774650JMedicaid
OK100774650IMedicaid
OK100774650HMedicaid