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CAH371309-01 PAWHUSKA HOSPITAL INC. (Active)
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Main Details
Name
PAWHUSKA HOSPITAL INC.
Subdivision Name
PAWHUSKA FAMILY MEDICAL CLINIC - FAMILY MEDICINE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH371309-01
Medicare Provider Number
371309
Outpatient Facility Provider Number
378532
Additional Details
Current Program Status
Active
Registration Date
10/11/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/15/2021
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Pawhuska Hospital, Inc.
Jason Timothy McBride, Administrator
(918) 287-3232
Primary Contact
Cohesive Healthcare Management & Consulting
Miranda Walz-Allen, Project Manager
(620) 213-2125
Addresses
Street Address
1109 E 15TH ST
Pawhuska, OK 74056
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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