Provider Demographics
NPI:1053715144
Name:MCALESTER REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:MCALESTER REGIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-426-1800
Mailing Address - Street 1:4 E CLARK BASS BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4269
Mailing Address - Country:US
Mailing Address - Phone:918-421-6090
Mailing Address - Fax:918-421-6094
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4269
Practice Address - Country:US
Practice Address - Phone:918-421-6090
Practice Address - Fax:918-421-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200456750HMedicaid
OKOKA105715Medicare PIN