Coal County General Hospital
Organization Active NPI Rural Health Clinic/Center · Atoka, OK
NPI 1639877871 · NPPES record last updated Oct 12, 2023
Key facts
- NPI
- 1639877871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- COAL COUNTY GENERAL HOSPITAL
- Practice address
- 1668 W Liberty Rd
Atoka, OK 74525-1703 - Phone
- (580) 889-3355
- Fax
- (580) 889-5272
- NPI assigned
- Feb 17, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- COAL COUNTY GENERAL HOSPITAL
Authorized official
- Name
- Trent Bourland
- Title
- Ceo
- Phone
- (580) 927-2327
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Change of ownership 1
Practitioners 23
-
Glee Darice Christ, APRN
-
Lauren Sandmann-Crow, PA-C
-
Tommie Gay Stanberry, PA-C
-
Ronda Michelle Thompson, APRN
-
Anthony James Nigliazzo, M.D.
-
Christie R. Carpenter, APRN-FNP-CNP
-
Bambi A Clay, PA-C
-
Sara Marie Coffey, D.O.
-
Kelly Dunn, MD
-
Ruth Elaine Fereday, PA-C
-
Brian Paul Freeland, PA-C
-
Alicia Rose Gosey, APRN-CNP
-
Chrissy Marie Lehew, APRN
-
Samuel Gene Martin, M.D.
-
Jodie H Moore, APRN-CNP
-
Stephanie Ranae Mowdy, APRN,MS,CCNS
-
Janet Nelson, APRN, FNP-C
-
Jana Del Sanders, APRN NP-C
-
Christopher Villarreal, P.A.
-
Bret Michael Bullard, ARNP, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D0956601 | Eastern Oklahoma Health Clinic of Atoka | Certificate of waiver | Jan 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Rural health clinic certification: CCN 378514
- Legal name
- COAL COUNTY GENERAL HOSPITAL
- Doing business as
- EASTERN OKLAHOMA HEALTH CLINIC OF ATOKA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 1, 2018
- Last certification
- Jun 18, 2024
- Ownership / control type
- 2A
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 1, 2004 in OK
- Enrollment address
- 1668 W Liberty Rd
Atoka, OK 74525-1703 - Related CCNs
- 371319
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Chris Martin |
Corporate Officer |
May 19, 2025 | |
| W-2 Managing Employee |
May 19, 2025 | ||
| Kevin Haney |
Corporate Director |
Feb 22, 2021 | |
| Jerad Gearhart |
Corporate Director |
Sep 27, 2021 | |
| Johnny Sandmann |
Corporate Director |
Sep 27, 2021 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jan 1, 2018 | Change of Ownership |
Abc Medical Clinic, Inc PLLC |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180730001593 | OK | Part a Provider - Rural Health Clinic | 8022901396 |
2 other NPIs on this enrollment Practice locations: Atoka, OK |
National Provider Directory
- Tax ID family
- Coal County General Hospital
- Part of
- Coal County General Hospital
Locations
1501 S Virginia Ave
Atoka, OK 74525
Phone (580) 889-3333
108 W Ohio Ave
Coalgate, OK 74538
Phone (580) 513-0743
6 N Covington St
Coalgate, OK 74538
Phone (580) 927-2327
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1668 W Liberty Rd
Atoka, OK 74525-1703
Mailing address
PO Box 326
Coalgate, OK 74538-0326
Phone (580) 927-2327
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100774650H | Medicaid | OK |
Other names
- Eastern Oklahoma Health Clinic of Atoka
- ABC Medical Clinic of Atoka
Other providers in Atoka, OK
- CHI Inc
- Choctaw Nation of Oklahoma
- Choctaw Nation of Oklahoma
- Glee Darice Christ
- Natasha Clayton
- Zachary Coates
- Amy Cochran
- Caleb Michael Cochran
- Jedidiah Patriot Cochran
- Kimberly Joann Coffee-Canler
All providers in Atoka, OK · Rural Health Clinic/Center in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.