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CAH371319-02 COAL COUNTY (Active)
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Main Details
Name
COAL COUNTY
Subdivision Name
ABC Medical Clinic of Holdenville - Rural Health Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH371319-02
Medicare Provider Number
371319
Outpatient Facility Provider Number
378513
Additional Details
Current Program Status
Active
Registration Date
1/14/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/18/2019
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Coal County General Hospital
Trent Bourland, Chief Executive Officer
(580) 927-2327 Ext: 250
Primary Contact
Coal County General Hospital
Paisley Burleson, Clinic Manager
(580) 927-2327 Ext: 342
Addresses
Street Address
1011 N Hinckley St
Holdenville, OK 74848
Billing Address
Coal County General Hospital
PO Box 326
Coalgate, OK 74538
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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