Healthcare Provider Details

I. General information

NPI: 1396785655
Provider Name (Legal Business Name): WATONGA HOSPITAL TRUST AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N CLARENCE NASH BLVD
WATONGA OK
73772-2845
US

IV. Provider business mailing address

500 N CLARENCE NASH BLVD PO BOX 370
WATONGA OK
73772-2845
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-7211
  • Fax: 580-623-7405
Mailing address:
  • Phone: 580-623-7211
  • Fax: 580-623-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2214
License Number StateOK

VIII. Authorized Official

Name: BARBARA A TALLANT
Title or Position: ADMINISTRATOR
Credential:
Phone: 580-623-7211