Healthcare Provider Details

I. General information

NPI: 1245837483
Provider Name (Legal Business Name): HASKELL REGIONAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N MAIN ST
GORE OK
74435-2013
US

IV. Provider business mailing address

10757 RANDOLPH ST
CROWN POINT IN
46307-7615
US

V. Phone/Fax

Practice location:
  • Phone: 918-489-5757
  • Fax: 918-489-5411
Mailing address:
  • Phone: 888-339-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRNJOT SINGH
Title or Position: PRESIDENT
Credential: MD
Phone: 888-339-7339