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General NPI Number Information
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NPI Number | 1295778231
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Entity Type | Organization
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Legal Business Name | CRAIG COUNTY HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 735 N FOREMAN ST
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City | VINITA
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State | OK
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Zip | 74301-1422
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Country | US
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Telephone | 918-256-7551
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Fax | 918-256-7395
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Provider Business Mailing Address
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Address Line | PO BOX 326
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City | VINITA
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State | OK
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Zip | 74301-0326
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Country | US
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Telephone | 918-256-7551
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Fax | 918-256-7395
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. REX WALK
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Credential | FACHE
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Telephone | 918-256-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 7139
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License Number State | OK
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