Provider Demographics
NPI:1992821326
Name:AHS PAWNEE HOSPITAL LLC
Entity type:Organization
Organization Name:AHS PAWNEE HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL RECORDS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HESKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-762-6369
Mailing Address - Street 1:1212 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-4046
Mailing Address - Country:US
Mailing Address - Phone:918-762-2577
Mailing Address - Fax:918-392-1995
Practice Address - Street 1:1212 4TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-4046
Practice Address - Country:US
Practice Address - Phone:918-762-2577
Practice Address - Fax:918-392-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000370060001OtherBCBS OKLAHOMA
OK000370060001OtherBCBS OKLAHOMA
OK37U060Medicare ID - Type UnspecifiedMEDICARE SWB