Healthcare Provider Details

I. General information

NPI: 1932634573
Provider Name (Legal Business Name): KAY COUNTY OKLAHOMA HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

IV. Provider business mailing address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

V. Phone/Fax

Practice location:
  • Phone: 580-718-4501
  • Fax: 580-718-4581
Mailing address:
  • Phone: 580-718-4501
  • Fax: 580-718-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2273
License Number StateOK

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953