Healthcare Provider Details

I. General information

NPI: 1750459756
Provider Name (Legal Business Name): COAL COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N COVINGTON ST
COALGATE OK
74538-2002
US

IV. Provider business mailing address

PO BOX 326
COALGATE OK
74538-0326
US

V. Phone/Fax

Practice location:
  • Phone: 580-927-2327
  • Fax: 580-927-2432
Mailing address:
  • Phone: 580-927-2327
  • Fax: 580-927-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2201
License Number StateOK

VIII. Authorized Official

Name: MR. TRENT A. BOURLAND
Title or Position: CEO
Credential:
Phone: 580-927-2327