Healthcare Provider Details

I. General information

NPI: 1356393110
Provider Name (Legal Business Name): DEACONESS HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N PORTLAND AVE
OKLAHOMA CITY OK
73112-2074
US

IV. Provider business mailing address

5501 N PORTLAND AVE
OKLAHOMA CITY OK
73112-2074
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-6000
  • Fax: 405-604-4437
Mailing address:
  • Phone: 405-604-6000
  • Fax: 405-604-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number2294
License Number StateOK

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565