Provider Demographics
NPI:1053353631
Name:LATIMER COUNTY HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:LATIMER COUNTY HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:918-465-2391
Mailing Address - Street 1:806 HIGHWAY 2 NORTH
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3625
Mailing Address - Country:US
Mailing Address - Phone:918-465-2391
Mailing Address - Fax:918-465-9350
Practice Address - Street 1:806 HIGHWAY 2 N
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-3625
Practice Address - Country:US
Practice Address - Phone:918-465-2391
Practice Address - Fax:918-465-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2204282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700860AMedicaid
OK100700860BMedicaid
OK100700860BMedicaid
370072Medicare Oscar/Certification