Basic Information
| Provider Information | |||||||||
| NPI: | 1841570629 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AHS CLAREMORE REGIONAL HOSPITAL LLC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HILLCREST HOSPITAL CLAREMORE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 N MUSKOGEE PL | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740173058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183412556 | ||||||||
| FaxNumber: | 9183423330 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 N MUSKOGEE PL | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740173058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183412556 | ||||||||
| FaxNumber: | 9183423330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | PETROVICH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP | ||||||||
| AuthorizedOfficialTelephone: | 6152963000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 2192 | OK | Y | Hospital Units | Psychiatric Unit |
No ID Information.