Healthcare Provider Details

I. General information

NPI: 1134451396
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 12 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HOSPITAL RD
FAIRFAX OK
74637
US

IV. Provider business mailing address

40 HOSPITAL RD
FAIRFAX OK
74637-5084
US

V. Phone/Fax

Practice location:
  • Phone: 918-642-3291
  • Fax: 918-642-3694
Mailing address:
  • Phone: 918-642-3291
  • Fax: 918-642-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateOK

VIII. Authorized Official

Name: TINA J STEELE
Title or Position: CEO
Credential:
Phone: 918-642-3291