1871320499 NPI number — STILLWATER MEDICAL CENTER AUTHORITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871320499 NPI number — STILLWATER MEDICAL CENTER AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STILLWATER MEDICAL CENTER AUTHORITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871320499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 802738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64180-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-742-5300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 E GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONKAWA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74653-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-308-3080
Provider Business Practice Location Address Fax Number:
833-973-4377
Provider Enumeration Date:
09/17/2024

Additional Information

Authorized Official

Authorized Official Last Name:
LOVELACE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
405-742-5729

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com