Provider Demographics
NPI:1871567958
Name:STILLWATER MEDICAL CENTER AUTHORITY
Entity type:Organization
Organization Name:STILLWATER MEDICAL CENTER AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-742-3959
Mailing Address - Street 1:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-2408
Mailing Address - Country:US
Mailing Address - Phone:405-624-6578
Mailing Address - Fax:405-624-6590
Practice Address - Street 1:1201 S. ADAMS
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4225
Practice Address - Country:US
Practice Address - Phone:405-624-6578
Practice Address - Fax:405-624-6590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STILLWATER MEDICAL CENTER AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-15
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7256251E00000X
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699950HMedicaid
OK100699950JMedicaid
OK377204Medicare ID - Type UnspecifiedMEDICARE ID