Healthcare Provider Details

I. General information

NPI: 1417099409
Provider Name (Legal Business Name): MUSKOGEE REGIONAL MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ROCKEFELLER DR
MUSKOGEE OK
74401-5075
US

IV. Provider business mailing address

300 ROCKEFELLER DR
MUSKOGEE OK
74401-5075
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-5501
  • Fax: 918-684-2552
Mailing address:
  • Phone: 918-682-5501
  • Fax: 918-684-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2177
License Number StateOK

VIII. Authorized Official

Name: DANIEL S SLIPKOVICH
Title or Position: CEO
Credential:
Phone: 615-764-3000