MEDICARE: OKLAHOMA HEART HOSPITAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center
2	284300000X	Special Hospital	2354	OK
3	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000370215001	OTHER	OK	BLUE CROSS BLUE SHIELD OK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083617005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA HEART HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	4050 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8382
Country	:	US
Telephone Number	:	405-608-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8382
Country	:	US
Telephone Number	:	405-608-3200
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	TRACY ENLOE
Credential	:
Telephone Number	:	405-608-3302

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/29/2023

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