Healthcare Provider Details

I. General information

NPI: 1598969974
Provider Name (Legal Business Name): ACADIANA HEALTHCARE OF OKLAHOMA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 KLABZUBA
PRAGUE OK
74864
US

IV. Provider business mailing address

3555 NW 58TH ST SUITE 200
OKLAHOMA CITY OK
73112-4707
US

V. Phone/Fax

Practice location:
  • Phone: 405-567-4922
  • Fax:
Mailing address:
  • Phone: 405-567-4922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT HICKS
Title or Position: CEO
Credential:
Phone: 405-567-4922