Provider Demographics
NPI:1548247489
Name:JANE PHILLIPS NOWATA HEALTH CENTER
Entity type:Organization
Organization Name:JANE PHILLIPS NOWATA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-273-3102
Mailing Address - Street 1:237 S. LOCUST
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-0426
Mailing Address - Country:US
Mailing Address - Phone:918-273-3102
Mailing Address - Fax:918-273-5490
Practice Address - Street 1:237 S. LOCUST
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-0426
Practice Address - Country:US
Practice Address - Phone:918-273-3102
Practice Address - Fax:918-273-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2187282NC0060X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700460AMedicaid
OK37Z305Medicare Oscar/Certification
OK371305Medicare Oscar/Certification