Basic Information
| Provider Information | |||||||||
| NPI: | 1114392875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREAT PLAINS REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11083 N 1970 RD | ||||||||
| Address2: | |||||||||
| City: | ELK CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736446412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803391139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ELK CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736445145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802252511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2015 | ||||||||
| LastUpdateDate: | 12/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | LIVELY | ||||||||
| AuthorizedOfficialFirstName: | COREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5802252511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NW0100X | 99035 | OK | Y | Hospitals | General Acute Care Hospital | Women |
No ID Information.