Provider Demographics
NPI:1588686679
Name:MAYES COUNTY HMA, LLC
Entity type:Organization
Organization Name:MAYES COUNTY HMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:111 N BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4201
Mailing Address - Country:US
Mailing Address - Phone:918-825-1600
Mailing Address - Fax:
Practice Address - Street 1:111 N BAILEY ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4201
Practice Address - Country:US
Practice Address - Phone:918-825-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2183261QM2500X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700040EMedicaid
OK100784710AMedicaid
OK200001840CMedicaid
OK200017970AMedicaid
OKP00216948OtherRAILROAD MEDICARE
OK100118840AMedicaid
OK241407503OtherMEDICARE PIN
OK100096890AMedicaid
OK100195450CMedicaid
OK24M802409OtherMEDICARE PIN
OK100133830BMedicaid
OKG001501005OtherMEDICARE PIN
OK100700040AMedicaid
OK200114640AMedicaid
OK241400717OtherMEDICARE PIN
OK249404202OtherMEDICARE PIN
OK100204600AMedicaid
OK100252290AMedicaid
OKG001501039OtherMEDICARE PIN
OKP00121324OtherRAILROAD MEDICARE
OK200075950CMedicaid
OK243726904OtherMEDICARE PIN
OK930013792OtherRAILROAD MEDICARE
OKG001501064OtherMEDICARE PIN
OKG37001501OtherMEDICARE PIN
OKP00130952OtherRAILROAD MEDICARE
OKP00450324OtherRAILROAD MEDICARE
OK200001840CMedicaid