Provider Demographics
NPI:1679711592
Name:FARMERS UNION HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:FARMERS UNION HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:IKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-225-2511
Mailing Address - Street 1:1800 W 1ST ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-3133
Mailing Address - Country:US
Mailing Address - Phone:580-225-4699
Mailing Address - Fax:580-243-6823
Practice Address - Street 1:1800 W 1ST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3133
Practice Address - Country:US
Practice Address - Phone:580-225-4699
Practice Address - Fax:580-243-6823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARMERS UNION HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2210261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2210OtherSTATE LICENSE