Provider Demographics
NPI:1871320499
Name:STILLWATER MEDICAL CENTER AUTHORITY
Entity type:Organization
Organization Name:STILLWATER MEDICAL CENTER AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-742-5729
Mailing Address - Street 1:PO BOX 802738
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2738
Mailing Address - Country:US
Mailing Address - Phone:405-742-5300
Mailing Address - Fax:
Practice Address - Street 1:105 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3503
Practice Address - Country:US
Practice Address - Phone:580-308-3080
Practice Address - Fax:833-973-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty