Healthcare Provider Details

I. General information

NPI: 1770752800
Provider Name (Legal Business Name): CRAIG COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S TREATY RD
MIAMI OK
74354-5330
US

IV. Provider business mailing address

PO BOX 326
VINITA OK
74301-0326
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-6644
  • Fax:
Mailing address:
  • Phone: 918-256-7551
  • Fax: 918-256-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2182
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number2182
License Number StateOK

VIII. Authorized Official

Name: MR. STEVEN CHASE
Title or Position: CEO
Credential:
Phone: 918-256-7551