Healthcare Provider Details

I. General information

NPI: 1356604987
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 9 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HIGHWAY 60 NORTHEAST
SEILING OK
73663
US

IV. Provider business mailing address

PO BOX 720
SEILING OK
73663-0720
US

V. Phone/Fax

Practice location:
  • Phone: 580-922-7361
  • Fax: 580-922-7718
Mailing address:
  • Phone: 580-922-7361
  • Fax: 580-922-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2256
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2256
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2256
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2256
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2256
License Number StateOK
# 6
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2256
License Number StateOK

VIII. Authorized Official

Name: MR. LARRY G TROXELL
Title or Position: CEO
Credential:
Phone: 580-922-7361