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General NPI Number Information
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NPI Number | 1396889606
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Entity Type | Organization
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Legal Business Name | FREEMAN-OAK HILL HEALTH SYSTEM
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 310 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6743
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Country | US
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Telephone | 918-542-7159
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Fax | 918-542-6320
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Provider Business Mailing Address
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Address Line | PO BOX 3810
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City | JOPLIN
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State | MO
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Zip | 64803-3810
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Country | US
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Telephone | 918-542-7159
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Fax | 918-542-6320
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Authorized Official
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Title or Position | VP
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Name | KEVIN P. GAUDETTE
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Credential |
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Telephone | 417-347-6277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2673
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License Number State | OK
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