Healthcare Provider Details

I. General information

NPI: 1407081490
Provider Name (Legal Business Name): CLC - EUFAULA COMMUNITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DRIVE
EUFAULA OK
74432-0629
US

IV. Provider business mailing address

138 EAST SPRING STREET SUITE 200
NEW ALBANY IN
47150-3457
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-2535
  • Fax:
Mailing address:
  • Phone: 812-949-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number2181
License Number StateOK

VIII. Authorized Official

Name: RODNEY EDWARD JEDLICKI
Title or Position: PRESIDENT
Credential:
Phone: 812-949-1838