Ahs Henryetta Hospital LLC
Organization Active NPI General Acute Care Hospital · Henryetta, OK
NPI 1720053556 · NPPES record last updated Feb 19, 2014
Key facts
- NPI
- 1720053556
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 2222 (OK)
- Legal business name
- AHS HENRYETTA HOSPITAL LLC
- Practice address
- Dewey Bartlett & Main
Henryetta, OK 74437-1269 - Phone
- (918) 579-7545
- Fax
- (918) 579-5570
- NPI assigned
- Feb 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Stephen C. Petrovich
- Title
- SVP
- Phone
- (615) 296-3000
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 3
Related certifications (CCN) 3
Facilities with the same owner 61
Practitioners 48
-
Michele Diane Crawley, APRN, CNP
-
Eric Mathis, DO
-
Stephanie A Rucquoy, APRN
-
Eugene O Dickens, M.D.
-
Julie Anne Knox, CRNA
-
Daniel Ray Asher, MD
-
Clint Justin Basener, D.O
-
Brawna Chowins, APRN-CNP
-
Marilyn Kay Culp, M.D.
-
Brent Wade Davis, D.O.
-
Melody Lynn Evans, FNP-C
-
Amie Kathryn Framel, ARNP
-
Susan Elaine Graham, DNP, APRN, FNP-BC
-
Rebecca Helms, APRN
Affiliated clinicians 135
-
Joel A Adkisson, D.O.
-
Zubair Ahmad, M.D.
-
Starla M Allen, D.O.
-
Kelli Ann Anderson, APRN, CNP
-
Dixitha Anugula, M.B.B.S
-
Daniel Ray Asher, MD
-
Amir Ashiq, MD
-
Caleb Barker, PA-C
-
Clint Justin Basener, D.O
-
Sandeep K Bhatia, M.D.
-
Benjamin Bradley, CNP
-
Breanna J Brumley, PA-C
-
William David Butron, M.D.
-
Mary Ann Cameron, MD
-
George J Carstens III, M.D.
-
Rajesh H Chandwaney, M.D.
-
Ankit K Chothani, M.B.;B.S.
-
Brawna Chowins, APRN-CNP
-
Timothy Condie, MD
Medicare Care Compare: Hospital
- Listed as
- Hillcrest Hospital Henryetta
- Type
- Acute Care Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Hospital certification: CCN 370183
- Legal name
- AHS HENRYETTA HOSPITAL LLC
- Doing business as
- HILLCREST HOSPITAL HENRYETTA
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1997
- Last certification
- Sep 15, 2021
- Beds
- 41
- Ownership / control type
- Private (for profit)
- Most recent change of ownership
- Nov 1, 2004 (2 total)
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 20, 2004 in DE
- Enrollment address
- 2401 W Main St
Henryetta, OK 74437-3893 - Hospital subgroups
- General
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Ardent Health Inc |
5% Or Greater Indirect Ownership Interest | Aug 4, 2015 | 100% |
| Kevin Gross |
Corporate Officer | Mar 1, 2014 | |
| W-2 Managing Employee |
Sep 1, 2021 | 100% | |
| Brian Walton |
Corporate Officer |
Jan 1, 2019 | |
| Carolyn Schneider |
Corporate Officer |
Aug 1, 2021 | |
| Ahs Oklahoma, LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2019 | 100% |
| Martin Bonick |
Corporate Officer |
Aug 19, 2020 | |
| Terika Richardson Mbanu |
Corporate Officer |
Sep 1, 2021 | |
| James Grimes |
Corporate Officer |
Sep 1, 2021 | |
| Ahs Hillcrest Healthcare System LLC |
5% Or Greater Direct Ownership Interest | Feb 6, 2009 | |
| Mary a Crabtree |
Corporate Officer |
Aug 20, 2004 | |
| Alfred Lumsdaine |
Corporate Officer |
Sep 1, 2021 | |
| Ahs Management Company Inc. |
Operational/Managerial Control | Jan 1, 2019 | 100% |
| Stephen C Petrovich |
Corporate Officer | Aug 20, 2004 | |
| Ardent Legacy Holdings LLC |
5% Or Greater Indirect Ownership Interest | Aug 4, 2015 | 100% |
| Ahp Health Partners, Inc |
5% Or Greater Indirect Ownership Interest | Jan 1, 2019 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040820000595 | OK | Part a Provider - Hospital | 9638143282 | Practice locations: Henryetta, OK |
| O20050219000008 | OK | Part B Supplier - Clinic/Group Practice | 9638143282 |
Receives reassigned benefits from 12 practitioners 3 other NPIs on this enrollment Practice locations: Henryetta, OK |
National Provider Directory
- Tax ID family
- Ahs Henryetta Hospital LLC
Locations
10502 N 110th East Ave
Owasso, OK 74055
Phone (918) 376-8000
Dept 2223
Tulsa, OK 74182
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 2222 | OK | Yes |
Addresses
Primary practice location
Dewey Bartlett & Main
Henryetta, OK 74437-1269
Mailing address
PO Box 1269
Dewey, Bartlett, Main
Henryetta, OK 74437-1269
Phone (918) 579-7545
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200045700C | Medicaid | OK |
Other names
- Hillcrest Hospital Henryetta
Other providers in Henryetta, OK
- A G Swinney MD Inc
- Ahs Henryetta Hospital LLC
- Ahs Henryetta Hospital LLC
- Ahs Henryetta Hospital LLC
- Air Evac EMS, Inc.
- Benjamin Alexander
- American Footcare Inc
- Beau Evans Family Dentistry PLLC
All providers in Henryetta, OK · General Acute Care Hospital in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2014. 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.