MEDICARE: SEQUOYAH COUNTY-CITY OF SALLISAW HOSPITAL AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043959141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUOYAH COUNTY-CITY OF SALLISAW HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	213 E REDWOOD AVE
Second Line	:
City	:	SALLISAW
State	:	OK
Zip	:	74955-2811
Country	:	US
Telephone Number	:	191-877-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 E REDWOOD AVE
Second Line	:
City	:	SALLISAW
State	:	OK
Zip	:	74955-3020
Country	:	US
Telephone Number	:	918-775-1619
Fax Number	:	918-775-1618

Authorized Official
Title or Position	:	DIRECTOR
Name	:	STEPHANIE SIX
Credential	:
Telephone Number	:	918-774-1100

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	04/20/2023

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