Basic Information
| Provider Information | |||||||||
| NPI: | 1568615656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY HOSPITAL HEALDTON, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 W MEMORIAL RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057523724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3462 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | HEALDTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 734386124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802290701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2008 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | ENLOE | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4057523161 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 2346 | OK | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.