Provider Demographics
NPI:1528319092
Name:SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-774-1161
Mailing Address - Street 1:213 E REDWOOD AVE
Mailing Address - Street 2:P.O. BOX 505
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2811
Mailing Address - Country:US
Mailing Address - Phone:918-774-1100
Mailing Address - Fax:918-774-1103
Practice Address - Street 1:213 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2811
Practice Address - Country:US
Practice Address - Phone:918-774-1100
Practice Address - Fax:918-774-1103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-25
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2189275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
37U112OtherSWING BED
OK2189OtherLICENSE
OK370112Medicare PIN