Basic Information
| Provider Information | |||||||||
| NPI: | 1720422785 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY HOSPITAL ADA, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748720850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803322323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 217 WEST SMITH ST | ||||||||
| Address2: | |||||||||
| City: | STRATFORD, | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803322323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2013 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | ROGERS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | KENT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5803322323 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.