Basic Information
| Provider Information | |||||||||
| NPI: | 1629057229 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AHS HILLCREST MEDICAL CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HILLCREST MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 S UTICA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185791000 | ||||||||
| FaxNumber: | 9185797599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 S UTICA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185791000 | ||||||||
| FaxNumber: | 9185797599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | DOBBS | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9185791000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 2264 | OK | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 200044210A | 05 | OK | MEDICAID | 000370001001 | 01 | OK | BC/BS OF OKLAHOMA | OTHER |