Basic Information
| Provider Information | |||||||||
| NPI: | 1518980978 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOLARA HOSPITAL MUSKOGEE,LLC | ||||||||
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| OtherOrganizationName: | CORNERSTONE SPECIALTY HOSPITALS BROKEN ARROW | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 ROSS AVE | ||||||||
| Address2: | STE 5400 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752017918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696216700 | ||||||||
| FaxNumber: | 4696216678 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 S 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186826161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | SCHULTZ | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4696216700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 2375 | OK | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 200119790A | 05 | OK | MEDICAID |