Provider Demographics
NPI:1912158098
Name:STATE OF OKLAHOMA
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA
Other - Org Name:BOARD OF REGENTS FOR OUHSC ON BEHALF OF GEORGE NIGH LTACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-9211
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-1118
Mailing Address - Country:US
Mailing Address - Phone:918-756-9211
Mailing Address - Fax:918-756-9452
Practice Address - Street 1:900 E AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-1118
Practice Address - Country:US
Practice Address - Phone:918-756-9211
Practice Address - Fax:918-756-9452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OKLAHOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHL2378282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHL2378OtherLICENSE
OKHL2378OtherLICENSE
OK370231Medicare Oscar/Certification