Basic Information
| Provider Information | |||||||||
| NPI: | 1932169950 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAULS VALLEY GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 VALLEY DRIVE | ||||||||
| Address2: | |||||||||
| City: | PAULS VALLEY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730756613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052385501 | ||||||||
| FaxNumber: | 4052385926 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 VALLEY DRIVE | ||||||||
| Address2: | |||||||||
| City: | PAULS VALLEY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052385501 | ||||||||
| FaxNumber: | 4052385926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | CHAPMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE EXEC | ||||||||
| AuthorizedOfficialTelephone: | 4052385501 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 2288 | OK | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100699890C | 05 | OK | MEDICAID | 100699890D | 05 | OK | MEDICAID | 100699890A | 05 | OK | MEDICAID |