Basic Information
| Provider Information | |||||||||
| NPI: | 1497057699 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CRAIG COUNTY HOSPITAL AUTHORITY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WELCH FAMILY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 59 | ||||||||
| Address2: | |||||||||
| City: | WELCH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743690059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187883919 | ||||||||
| FaxNumber: | 9187883914 | ||||||||
| Practice Location | |||||||||
| Address1: | 343 S. COMMERCIAL ST. | ||||||||
| Address2: | |||||||||
| City: | WELCH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743690000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187883919 | ||||||||
| FaxNumber: | 9187883914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2010 | ||||||||
| LastUpdateDate: | 03/03/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRUM | ||||||||
| AuthorizedOfficialFirstName: | HERBERT | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9182567551 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 2182 | OK | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.