Organization
WAGONER HOSPITAL AUTHORITY
Active
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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