Basic Information
Provider Information
NPI: 1750334090
EntityType: 2
ReplacementNPI:  
OrganizationName: WOODWARD HEALTH SYSTEM LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ALLIANCEHEALTH WOODWARD
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 849110
Address2:  
City: DALLAS
State: TX
PostalCode: 752850001
CountryCode: US
TelephoneNumber: 5802565511
FaxNumber: 5802548418
Practice Location
Address1: 900 17TH ST
Address2:  
City: WOODWARD
State: OK
PostalCode: 738012448
CountryCode: US
TelephoneNumber: 5802565511
FaxNumber: 5802548418
Other Information
ProviderEnumerationDate: 05/18/2006
LastUpdateDate: 04/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LALOR
AuthorizedOfficialFirstName: PAULA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR/DELEGATED OFFICIAL
AuthorizedOfficialTelephone: 6292153953
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: WOODWARD HEALTH SYSTEM LLC
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
275N00000X2252OKY Hospital UnitsMedicare Defined Swing Bed Unit 

ID Information
IDTypeStateIssuerDescription
200019120A05OK MEDICAID


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