Healthcare Provider Details

I. General information

NPI: 1265602056
Provider Name (Legal Business Name): CRAIG COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26300 S HIGHWAY 125
AFTON OK
74331-6282
US

IV. Provider business mailing address

PO BOX 326
VINITA OK
74301-0326
US

V. Phone/Fax

Practice location:
  • Phone: 918-257-8585
  • Fax: 918-257-8560
Mailing address:
  • Phone: 918-256-7551
  • Fax: 918-256-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2182
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number2182
License Number StateOK

VIII. Authorized Official

Name: MR. HERBERT F. CRUM JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 918-256-7551