Provider Demographics
NPI:1750527768
Name:PRAGUE HEALTHCARE AUTHORITY
Entity type:Organization
Organization Name:PRAGUE HEALTHCARE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-567-4922
Mailing Address - Street 1:PO DRAWER S
Mailing Address - Street 2:1322 KLABZUBA AVENUE
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-1090
Mailing Address - Country:US
Mailing Address - Phone:405-567-4922
Mailing Address - Fax:405-567-4290
Practice Address - Street 1:1322 KLABZUBA AVENUE
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864
Practice Address - Country:US
Practice Address - Phone:405-567-4922
Practice Address - Fax:405-567-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2164282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200231400BMedicaid
OK371301Medicare Oscar/Certification