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
DEBI HAMILTON (CHAIRMAN)
(918) 485-5514
Entity
Organization
Contact information
Practice address
3501 W BROADWAY ST, MUSKOGEE, OK 74401-2138
(918) 913-9408
Mailing address
1200 W CHEROKEE ST, WAGONER, OK 74467-4624
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2298
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100890A
—
OK
05
—
200100890B
—
OK
01
—
300522264
MEDICARE CLINIC PROVIDER NUMBER
—
Enumeration date
05/13/2013
Last updated
03/07/2018
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