Provider Demographics
NPI:1528812237
Name:CLINTON HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:CLINTON HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-454-6058
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-1177
Mailing Address - Country:US
Mailing Address - Phone:580-323-0261
Mailing Address - Fax:580-323-3546
Practice Address - Street 1:100 N 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3117
Practice Address - Country:US
Practice Address - Phone:580-547-5128
Practice Address - Fax:580-547-5011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINTON HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty