Provider Demographics
NPI:1396785655
Name:WATONGA HOSPITAL TRUST AUTHORITY
Entity type:Organization
Organization Name:WATONGA HOSPITAL TRUST AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-623-7211
Mailing Address - Street 1:500 N CLARENCE NASH BLVD
Mailing Address - Street 2:PO BOX 370
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-2845
Mailing Address - Country:US
Mailing Address - Phone:580-623-7211
Mailing Address - Fax:580-623-7405
Practice Address - Street 1:500 N CLARENCE NASH BLVD
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-2845
Practice Address - Country:US
Practice Address - Phone:580-623-7211
Practice Address - Fax:580-623-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2214282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700210EMedicaid
OK000370005001OtherBLUE CROSS BLUE SHIELD
OK100200710AMedicaid
OK700700210CMedicaid
OK700700210CMedicaid
OK100700210EMedicaid