1114143252 NPI number — MEMORIAL HOSPITAL OF TEXAS COUNTY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114143252 NPI number — MEMORIAL HOSPITAL OF TEXAS COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HOSPITAL OF TEXAS COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114143252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HCR #4 BOX 80
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUYMON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-338-8136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUYMON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-338-6515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HELM
Authorized Official First Name:
LYNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST ASSIST.
Authorized Official Telephone Number:
580-338-6515

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  TA516 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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