Provider Demographics
NPI:1992719306
Name:WARD AND HALL, PC
Entity type:Organization
Organization Name:WARD AND HALL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CPOA
Authorized Official - Phone:918-756-0316
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:300 CREEK PLACE
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-0520
Mailing Address - Country:US
Mailing Address - Phone:918-756-0316
Mailing Address - Fax:918-756-2022
Practice Address - Street 1:300 CREEK PL
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6730
Practice Address - Country:US
Practice Address - Phone:918-756-0316
Practice Address - Fax:918-756-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100748120AMedicaid
OK400522031Medicare ID - Type UnspecifiedGROUP NUMBER
OK1271180002Medicare NSC
OK400522031Medicare PIN