Healthcare Provider Details

I. General information

NPI: 1104968916
Provider Name (Legal Business Name): MUSKOGEE REGIONAL MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ROCKEFELLER DR
MUSKOGEE OK
74401-5075
US

IV. Provider business mailing address

103 CONTINENTAL PL SUITE 200
BRENTWOOD TN
37027-1041
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-5501
  • Fax: 918-684-2552
Mailing address:
  • Phone: 615-844-9800
  • Fax: 615-844-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2177
License Number StateOK

VIII. Authorized Official

Name: STEPHEN L PAGE
Title or Position: CEO
Credential:
Phone: 615-844-9800