Organization
BLACKWELL HMA LLC
Active
Other names
AllianceHealth Blackwell
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE HOLTSFORD (AUTHORIZED OFFICIAL)
(615) 465-7466
Entity
Organization
Contact information
Practice address
710 S 13TH ST, BLACKWELL, OK 74631-3700
(580) 363-2311
Mailing address
710 S 13TH ST, BLACKWELL, OK 74631-3700
(580) 363-2311
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
7335
OK
282N00000X
General Acute Care Hospital
Primary
2281
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100700340A
—
OK
01
—
100700340C
MEDICAID
OK
01
—
CK5284
RAILROAD MEDICARE GROUP
OK
Enumeration date
07/22/2006
Last updated
07/23/2015
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