Organization
ST JOHN SAPULPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANITA L RALEY MS, MHA (DIRECTOR OF OPERATIONS)
(918) 224-4280
Entity
Organization
Contact information
Practice address
1004 E BRYAN AVE, SAPULPA, OK 74066-4513
(918) 224-4280
(918) 227-3927
Mailing address
PO BOX 1368, 1004 N BRYAN, SAPULPA, OK 74067-1368
(918) 224-4280
(918) 227-3927
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
2310
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00037003301
MEDICARE
OK
05
—
100699550D
—
OK
Enumeration date
12/02/2010
Last updated
12/02/2010
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