Healthcare Provider Details

I. General information

NPI: 1114174588
Provider Name (Legal Business Name): MCALESTER REGIONAL HOSPITALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CLARK BASS BLVD MARKETING BUILDING
MCALESTER OK
74501-4209
US

IV. Provider business mailing address

1 E CLARK BASS BLVD MARKETING BUILDING
MCALESTER OK
74501-4209
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-1800
  • Fax: 918-421-6824
Mailing address:
  • Phone: 918-426-1800
  • Fax: 918-421-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2203
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2203
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2203
License Number StateOK

VIII. Authorized Official

Name: MRS. EMILY E MOUSER
Title or Position: VP HR
Credential:
Phone: 918-426-1800