Healthcare Provider Details

I. General information

NPI: 1144245655
Provider Name (Legal Business Name): JEFFERSON COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. HIGHWAYS 70 & 81
WAURIKA OK
73573-0090
US

IV. Provider business mailing address

PO BOX 90
WAURIKA OK
73573-0090
US

V. Phone/Fax

Practice location:
  • Phone: 580-228-2344
  • Fax: 580-228-3410
Mailing address:
  • Phone: 580-228-2344
  • Fax: 580-228-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2233
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2233
License Number StateOK

VIII. Authorized Official

Name: MR. RICHARD L GILLESPIE
Title or Position: CEO
Credential: FACHE
Phone: 580-228-2344