NPIMap

Organization Active NPI

Leflore County Hospital Authority

Doing business as Mountain Gateway Senior Health

  • Psychiatric Hospital Unit
  • Poteau, OK
National Provider Identifier
1184997447
Registry record updated May 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
LEFLORE COUNTY HOSPITAL AUTHORITY
Doing business as
Mountain Gateway Senior Health
Practice address
105 Wall St
Poteau, OK 74953-4433
Phone
(918) 647-8161
NPI assigned
Feb 17, 2012
Last updated
May 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael J Carter
Title
Ceo/Administrator
Phone
(918) 635-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X OK Primary

Addresses

Primary practice location

105 Wall St
Poteau, OK 74953-4433

Mailing address

PO Box 1148
Poteau, OK 74953-1148
Phone (918) 647-8161

Other names 1

  • Mountain Gateway Senior Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150520000247 OK Part A Provider - Critical Access Hospital 7719916956 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Poteau, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184997447. Details of each certification follow.

Hospital certification: CCN 371337

Legal name
LEFLORE COUNTY HOSPITAL AUTHORITY
Doing business as
EASTERN OKLAHOMA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 22, 2016
Last certification
Nov 2, 2023
Beds
25
Ownership / control type
Local
Organization structure
OtherNon-profit
Incorporated
Jul 6, 1977 in OK
Enrollment address
105 Wall St
Poteau, OK 74953-4433
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Eastern Oklahoma Medical CenterCCN 371337 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bradley Dedmon Individual Operational/Managerial ControlBoard Member Jan 1, 2021
Carl Robert Reed Individual Corporate DirectorSecretary of the Board May 1, 2014
Logan Hayes Individual Corporate OfficerCoo May 23, 2023
Garry Ivey Individual OtherBoard Member Jan 1, 2021
Darla Ford Individual W-2 Managing EmployeeChief Nursing Officer Jan 1, 2020
Leflore County Hospital Authority Organization, Poteau, OK Operational/Managerial Control Apr 1, 2015
Joe Mode Individual Operational/Managerial ControlBoard Member Jul 1, 2021
Tiffany B Griffis Individual Corporate OfficerCeo Aug 28, 2023
Audrey Balentine Individual Operational/Managerial ControlBoard Member Jul 19, 2019
Jerry Andrews Individual Corporate DirectorChairman of the Board Jul 1, 2010

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 99

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 99

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1184997447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1148",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749531148",
            "telephone_number": "918-647-8161",
            "fax_number": "918-635-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WALL ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534433",
            "telephone_number": "918-647-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEFLORE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-17",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "918-635-3300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Gateway Senior Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poteau, OK

Sources for this page

Verify at the official NPI Registry.