Organization
AHS PRYOR HOSPITAL, LLC
Active
Other names
Utica Park Clinic Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN C. PETROVICH (EVP)
(615) 296-3000
Entity
Organization
Contact information
Practice address
1301 NE 1ST ST STE 400, PRYOR, OK 74361
(918) 824-8000
(918) 825-5505
Mailing address
1301 NE 1ST ST STE 400, PRYOR, OK 74361-8851
(918) 824-8000
(918) 825-5505
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/12/2018
Last updated
06/04/2019
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