Healthcare Provider Details

I. General information

NPI: 1568472090
Provider Name (Legal Business Name): HEALDTON MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 S 8TH ST
HEALDTON OK
73438-2424
US

IV. Provider business mailing address

918 S 8TH ST
HEALDTON OK
73438-2424
US

V. Phone/Fax

Practice location:
  • Phone: 580-229-0701
  • Fax: 580-229-1454
Mailing address:
  • Phone: 580-229-0701
  • Fax: 580-229-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2346
License Number StateOK

VIII. Authorized Official

Name: MR. RICKLIN PACK
Title or Position: ADMINISTRATOR
Credential:
Phone: 580-229-0701