Basic Information
| Provider Information | |||||||||
| NPI: | 1114174588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCALESTER REGIONAL HOSPITALIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 E CLARK BASS BLVD | ||||||||
| Address2: | MARKETING BUILDING | ||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745014209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184261800 | ||||||||
| FaxNumber: | 9184216824 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 E CLARK BASS BLVD | ||||||||
| Address2: | MARKETING BUILDING | ||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745014209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184261800 | ||||||||
| FaxNumber: | 9184216824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 08/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | MOUSER | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | VP HR | ||||||||
| AuthorizedOfficialTelephone: | 9184261800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2203 | OK | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208600000X | 2203 | OK | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 208M00000X | 2203 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 200213440A | 05 | OK | MEDICAID | DP4386 | 01 | OK | RAILROAD MEDICARE | OTHER |