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General NPI Number Information
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NPI Number | 1780709550
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Entity Type | Organization
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Legal Business Name | SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1109 E CHEROKEE AVE
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City | SALLISAW
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State | OK
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Zip | 74955-5035
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Country | US
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Telephone | 918-774-1100
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Fax | 918-774-1103
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Provider Business Mailing Address
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Address Line | PO BOX 505
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City | SALLISAW
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State | OK
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Zip | 74955-0505
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Country | US
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Telephone | 918-774-1100
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Fax | 918-774-1103
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES E. WADE
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Credential |
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Telephone | 918-774-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 2189
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License Number State | OK
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