Healthcare Provider Details

I. General information

NPI: 1508896499
Provider Name (Legal Business Name): ATOKA COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WEST LIBERTY ROAD
ATOKA OK
74525-1621
US

IV. Provider business mailing address

1200 WEST LIBERTY ROAD
ATOKA OK
74525-1621
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-3333
  • Fax: 580-889-4225
Mailing address:
  • Phone: 580-889-3333
  • Fax: 580-889-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2205
License Number StateOK

VIII. Authorized Official

Name: MR. CHARLES E. YOUNG
Title or Position: CEO
Credential: MS
Phone: 580-889-3333