Healthcare Provider Details

I. General information

NPI: 1609666593
Provider Name (Legal Business Name): WEATHERFORD HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 N BROADWAY AVE
HYDRO OK
73048
US

IV. Provider business mailing address

3701 E MAIN ST
WEATHERFORD OK
73096-3309
US

V. Phone/Fax

Practice location:
  • Phone: 580-772-5551
  • Fax:
Mailing address:
  • Phone: 580-774-4778
  • Fax: 580-774-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGANNA LEA BUSS
Title or Position: CFO
Credential:
Phone: 580-774-4762