Provider Demographics
NPI:1730434424
Name:WOODWARD HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:WOODWARD HEALTH SYSTEM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:900 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2448
Mailing Address - Country:US
Mailing Address - Phone:580-256-5511
Mailing Address - Fax:
Practice Address - Street 1:1818 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2912
Practice Address - Country:US
Practice Address - Phone:580-254-3396
Practice Address - Fax:580-254-5311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODWARD HEALTH SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-18
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200019120IMedicaid
OK373476Medicare Oscar/Certification