Healthcare Provider Details

I. General information

NPI: 1073683298
Provider Name (Legal Business Name): HOLDENVILLE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S WASHITA ST
WETUMKA OK
74883-5524
US

IV. Provider business mailing address

100 MCDOUGAL DRIVE
HOLDENVILLE OK
74848
US

V. Phone/Fax

Practice location:
  • Phone: 405-452-5558
  • Fax: 405-452-5557
Mailing address:
  • Phone: 405-379-4200
  • Fax: 405-379-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2195
License Number StateOK

VIII. Authorized Official

Name: BRIDGET COSBY
Title or Position: CFO
Credential:
Phone: 405-379-4200