Healthcare Provider Details

I. General information

NPI: 1558314898
Provider Name (Legal Business Name): WOODWARD HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 17TH ST
WOODWARD OK
73801-2448
US

IV. Provider business mailing address

PO BOX 849110
DALLAS TX
75286-0001
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-5511
  • Fax: 580-254-8418
Mailing address:
  • Phone: 580-256-5511
  • Fax: 580-254-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number2252
License Number StateOK

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: DIRECTOR, BUSINESS OFFICE SERVICES
Credential:
Phone: 615-465-7466