Healthcare Provider Details

I. General information

NPI: 1538592332
Provider Name (Legal Business Name): MCALESTER REGIONAL HEALTH CENTER MRHC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CLARK BASS BLVD ATTN: TYRA ROLAN
MCALESTER OK
74501-4209
US

IV. Provider business mailing address

1 E CLARK BASS BLVD ATTN: TYRA ROLAN
MCALESTER OK
74501-4209
US

V. Phone/Fax

Practice location:
  • Phone: 918-421-6987
  • Fax: 918-421-6998
Mailing address:
  • Phone: 918-421-6987
  • Fax: 918-421-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TYRA ROLAN
Title or Position: PHY PRAC COORDINATOR
Credential:
Phone: 918-421-6987