Healthcare Provider Details

I. General information

NPI: 1538432984
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 9 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/19/2013
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2256
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2256
License Number StateOK

VIII. Authorized Official

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