Provider Demographics
NPI:1407081490
Name:CLC - EUFAULA COMMUNITY HOSPITAL, INC.
Entity type:Organization
Organization Name:CLC - EUFAULA COMMUNITY HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JEDLICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-949-1838
Mailing Address - Street 1:138 EAST SPRING STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-3457
Mailing Address - Country:US
Mailing Address - Phone:812-949-1838
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-0629
Practice Address - Country:US
Practice Address - Phone:918-689-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY LIFECARE COPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2181282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK370169OtherMEDICARE PROVIDER NUMBER