Basic Information
| Provider Information | |||||||||
| NPI: | 1992821326 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AHS PAWNEE HOSPITAL LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | PAWNEE MUNICIPAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 4TH ST | ||||||||
| Address2: | |||||||||
| City: | PAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740584046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187622577 | ||||||||
| FaxNumber: | 9183921995 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 4TH ST | ||||||||
| Address2: | |||||||||
| City: | PAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740584046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187622577 | ||||||||
| FaxNumber: | 9183921995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HESKETT | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL RECORDS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9187626369 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 000370060001 | 01 | OK | BCBS OKLAHOMA | OTHER |