Organization
WAGONER HOSPITAL AUTHORITY
Active
Parent organization
WAGONER HOSPITAL AUTHORITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAGONER HOSPITAL AUTHORITY
Authorized official
JUDITH ELIZABETH BROWN (BUSINESS OPERATIONS DIRECTOR)
(918) 485-1297
Entity
Organization
Contact information
Practice address
1202 W CHEROKEE ST STE E, WAGONER, OK 74467-4629
(918) 485-1877
(918) 485-0535
Mailing address
1200 W CHEROKEE ST, WAGONER, OK 74467-4624
(918) 485-5514
(918) 485-9701
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
2298
OK
282N00000X
General Acute Care Hospital
2298
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100890A
—
OK
01
—
200100890B
MEDICAID HOSPITAL BILLING #
OK
05
—
200100890C
—
OK
01
—
300522264
MEDICARE PART B GROUP #
OK
Enumeration date
08/18/2009
Last updated
04/27/2021
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