Healthcare Provider Details

I. General information

NPI: 1144212556
Provider Name (Legal Business Name): PUSHMATAHA COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E MAIN ST
ANTLERS OK
74523-3262
US

IV. Provider business mailing address

PO BOX 518
ANTLERS OK
74523-0518
US

V. Phone/Fax

Practice location:
  • Phone: 580-298-3341
  • Fax: 580-298-4713
Mailing address:
  • Phone: 580-298-3341
  • Fax: 580-298-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number2199
License Number StateOK

VIII. Authorized Official

Name: MR. NICK P ROWLAND
Title or Position: CEO
Credential:
Phone: 580-298-3341