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Organization

WAGONER HOSPITAL AUTHORITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DEBI HAMILTON (CHAIRMAN)
(918) 485-5514
Entity
Organization

Contact information

Practice address
1200 W CHEROKEE ST, WAGONER, OK 74467-4624
(918) 485-5514
(918) 485-9701
Mailing address
1200 W CHEROKEE ST, WAGONER, OK 74467-4624
(918) 485-5514
(918) 485-9701

Taxonomy

Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
2298
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
200100890A
MEDICAID PROVIDER NUMBER FOR PHYSICIAN BILLING
OK
05
200100890B
OK
01
300522264
MEDICARE CLINIC PROVIDER NUMBER
OK
Enumeration date
03/07/2006
Last updated
04/27/2021
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