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General NPI Number Information
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NPI Number | 1942754510
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Entity Type | Organization
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Legal Business Name | JEFFERSON COUNTY HEALTHCARE AUTHORITY
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 9172 US HWY 70 INTERSECTION HWYS 70 & 81
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City | WAURIKA
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State | OK
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Zip | 73573-0090
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Country | US
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Telephone | 580-228-3669
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Fax | 580-228-2529
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Provider Business Mailing Address
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Address Line | 9172 US HWY 70 INTERSECTION HWYS 70&81
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City | WAURIKA
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State | OK
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Zip | 73573-0090
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Country | US
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Telephone | 580-228-3669
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Fax | 580-228-2529
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Authorized Official
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Title or Position | CEO
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Name | RICHARD GILLESPIE
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Credential |
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Telephone | 580-228-2344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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