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Organization Active NPI

Sequoyah County City of Sallisaw Hospital Authority

  • Community Based Hospice Care Agency
  • Sallisaw, OK
National Provider Identifier
1871654087
Registry record updated Apr 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Practice address
213 E Redwood
Sallisaw, OK 74955-2811
Phone
(918) 774-1100
Fax
(918) 774-1142
NPI assigned
Dec 12, 2006
Organization subpart
Yes
Parent organization
SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2012

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

Authorized official

Name
Mrs. Debra R. Knoke
Title
Ceo
Phone
(918) 774-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

213 E Redwood
Sallisaw, OK 74955-2811

Mailing address

213 E Redwood
Sallisaw, OK 74955-2811
Phone (918) 774-1100

Other identifiers 1

IdentifierTypeStateIssuer
100700190SMedicaidOK

Other names 1

  • Sequoyah Memorial Hospital Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080222000454 OK Part A Provider - Hospice 1759282239 Practice locations: Sallisaw, OK

Hospice certification: CCN 371529

Legal name
SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
Doing business as
NORTHEASTERN HEALTH SYSTEM SEQUOYAH
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 8, 1994
Last certification
Jul 13, 2021
Ownership / control type
Government - City-County
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1966 in OK
Enrollment address
213 E Redwood Ave
Sallisaw, OK 74955-2811

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Northeastern Health System SequoyahCCN 371529
Ownership
Government
Certified
Jun 8, 1994
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Sequoyah County City Trust14 organizations share this tax ID, including this one
Part of
Sequoyah County City Trust

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Debbie Bartel Individual Corporate OfficerTrustee Board Member Jul 1, 2011
John Mayhan Individual Corporate OfficerVice Chairman Board Member Jul 1, 1990
Eric Carter Individual Corporate DirectorDirector of Operations Mar 7, 2020 100%
Katrina Cottrell Individual W-2 Managing EmployeeDirector of Hospice May 5, 2023
Todd Martin Individual Corporate OfficerSec Treasurer Board Member Jul 1, 2008

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northeastern Health System SequoyahSallisaw, OK, CCN 370112 Hospital Operational/Managerial Control (100%) Jul 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1871654087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 E REDWOOD",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749552811",
            "telephone_number": "918-774-1100",
            "fax_number": "918-774-1142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 E REDWOOD",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749552811",
            "telephone_number": "918-774-1100",
            "fax_number": "918-774-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "KNOKE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-774-1100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700190S",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sequoyah Memorial Hospital Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sallisaw, OK

Sources for this page

Verify at the official NPI Registry.