Provider Demographics
NPI:1912420928
Name:LEFLORE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:LEFLORE COUNTY HOSPITAL AUTHORITY
Other - Org Name:SWING BED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-635-3310
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953
Mailing Address - Country:US
Mailing Address - Phone:918-635-3310
Mailing Address - Fax:918-635-3308
Practice Address - Street 1:105 WALL ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4433
Practice Address - Country:US
Practice Address - Phone:918-635-3310
Practice Address - Fax:918-635-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2174275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700730Medicaid