Individual provider Active NPI

Elizabeth Morgan Haddock, PA-C

  • Physician Assistant
  • Tishomingo, OK
National Provider Identifier
1376036616
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2817 Issued in OK
Practice address
1000 S Byrd St
Tishomingo, OK 73460
Phone
(580) 371-2327
Fax
(580) 371-2127
NPI assigned
Jun 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2817 OK Primary

Addresses

Primary practice location

1000 S Byrd St
Tishomingo, OK 73460

Mailing address

1000 S Byrd St
Tishomingo, OK 73460-3265
Phone (580) 371-2327

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180801000294 OK Practitioner - Physician Assistant 1355698705 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital Healdton IncGroup PAC ID 3375610447, 13 clinicians

Practice addresses (Care Compare)

3462 Hospital Rd
Healdton, OK 73438-6124
Phone (580) 229-0701

3472 Hospital Rd
Healdton, OK 73438-6124
Phone (580) 229-0079

Hospital & facility affiliations

  • Mercy Hospital Healdton, Inc. Hospital, Healdton, OK, CCN 371310

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2817OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County, Inc CurrentSince Sep 24, 2018 Accepting new patients
Mercy Hospital Kingfisher, Inc CurrentSince Jan 1, 2019 Accepting new patients
Mercy Hospital Tishomingo, Inc. CurrentSince Jul 23, 2018 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince Sep 24, 2018 Accepting new patients
Mercy Hospital Healdton, Inc. CurrentSince Nov 13, 2022 Accepting new patients
Mercy Hospital Watonga Inc CurrentSince Jul 23, 2018 Accepting new patients
Mercy Hospital El Reno, Inc Past Accepting new patients

Locations

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

3462 Hospital Rd
Healdton, OK 73438
Phone (580) 229-0701

1000 Hospital Dr
Kingfisher, OK 73750
Phone (405) 375-3141

1000 S Byrd St
Tishomingo, OK 73460
Phone (580) 371-2327

500 N Clarence Nash Blvd
Watonga, OK 73772
Phone (580) 623-2233

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1376036616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S BYRD ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603265",
            "telephone_number": "580-371-2327",
            "fax_number": "580-371-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BYRD ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "73460",
            "telephone_number": "580-371-2327",
            "fax_number": "580-371-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDOCK",
        "first_name": "ELIZABETH",
        "middle_name": "MORGAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-12",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, OK

Sources for this page

Verify at the official NPI Registry.