MEDICARE: RURAL HEALTHCARE OF OKLAHOMA, INC

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	282N00000X	General Acute Care Hospital	2353	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285626424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL HEALTHCARE OF OKLAHOMA, INC

Provider Business Mailing Address
First Line	:	2815 E JACKSON ST
Second Line	:
City	:	HUGO
State	:	OK
Zip	:	74743-4250
Country	:	US
Telephone Number	:	580-326-9200
Fax Number	:	580-317-2810

Provider Business Practice Location Address
First Line	:	2815 E JACKSON ST
Second Line	:
City	:	HUGO
State	:	OK
Zip	:	74743-4250
Country	:	US
Telephone Number	:	580-326-9200
Fax Number	:	580-317-2810

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT F BERRY
Credential	:
Telephone Number	:	512-626-2751

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	06/24/2010

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