Provider Demographics
NPI:1902812308
Name:WARD AND HALL, PC
Entity Type:Organization
Organization Name:WARD AND HALL, PC
Other - Org Name:
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:
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 1:11920 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2170
Practice Address - Country:US
Practice Address - Phone:918-369-3937
Practice Address - Fax:918-369-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
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
OK100748120DMedicaid
OK100748120DMedicaid