MEDICARE: COAL COUNTY GENERAL HOSPITAL

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	282NC0060X	Critical Access Hospital	2201	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	:	1629077227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAL COUNTY GENERAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 326
Second Line	:
City	:	COALGATE
State	:	OK
Zip	:	74538-0326
Country	:	US
Telephone Number	:	580-927-2327
Fax Number	:	580-927-2439

Provider Business Practice Location Address
First Line	:	6 N COVINGTON ST
Second Line	:
City	:	COALGATE
State	:	OK
Zip	:	74538-2002
Country	:	US
Telephone Number	:	580-927-2327
Fax Number	:	580-927-2439

Authorized Official
Title or Position	:	CEO
Name	:	TRENT BOURLAND
Credential	:
Telephone Number	:	580-927-2327

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/29/2022

Similar Medicare Providers

1750459756 — COAL COUNTY GENERAL HOSPITAL
Practice Location Address:

6 N COVINGTON ST
COALGATE, OK
74538-2002

Practice Phone: 580-927-2327
Practice Fax: 580-927-2432

1609093848 — MR. STEPHEN JOHN PENNEY P.T.
Practice Location Address:

6 N COVINGTON ST
COALGATE, OK
74538-2002

Practice Phone: 580-927-2327
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1730357922 — COAL COUNTY GENERAL HOSPITAL
Practice Location Address:

6 N COVINGTON ST
COALGATE, OK
74538-2002

Practice Phone: 580-927-2327
Practice Fax: 580-927-2499

1730182908 — CITY OF COALGATE
Practice Location Address:

3 S MAIN ST
COALGATE, OK
74538-2838

Practice Phone: 580-927-3913
Practice Fax: 580-927-3200

1639178130 — COAL COUNTY EXTENDED CARE INCORPORATED
Practice Location Address:

7 N COVINGTON ST
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74538-2001

Practice Phone: 580-927-2000
Practice Fax: 580-927-9940

1609847573 — COTTONWOOD PUBLIC SCHOOL
Practice Location Address:

LUBBIS ST , 2 MI NE OF COALGATE OK ON STATE HWY 31
COTTONWOOD, OK
74538-0347

Practice Phone: 580-927-2937
Practice Fax: 580-927-2938

Directions to “COAL COUNTY GENERAL HOSPITAL ” Practice Location

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