Organization
COMMUNITY HOSPITAL LLC
Active
Parent organization
COMMUNITY HOSPITAL LLC
Other names
Community Hospital Pro Fee Grp
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY HOSPITAL LLC
Authorized official
NICHOLAS CRAFTS (OFFICER / AUTHORIZED OFFICIAL)
(832) 729-4009
Entity
Organization
Contact information
Practice address
3100 SW 89TH STREET, OKLAHOMA CITY, OK 73159
(405) 602-8100
(405) 602-8103
Mailing address
14201 DALLAS PKWY, DALLAS, TX 75254-2916
(405) 602-8100
(405) 602-8103
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746230A
—
OK
01
—
DE2280
RAILROAD MEDICARE #
OK
Enumeration date
01/31/2008
Last updated
10/09/2024
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