MEDICARE: OKMULGEE MEMORIAL HOSPITAL, INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	2165	OK

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000370057001	OTHER	OK	BLUE CROSS

NPI Number	:	1083616221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKMULGEE MEMORIAL HOSPITAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 1038
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-1038
Country	:	US
Telephone Number	:	918-756-4233
Fax Number	:	918-756-5968

Provider Business Practice Location Address
First Line	:	1401 MORRIS DRIVE
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6429
Country	:	US
Telephone Number	:	918-756-4233
Fax Number	:	918-756-5968

Authorized Official
Title or Position	:	DIRECTOR/IT
Name	:	MRS. SHARON RENEE RIKER
Credential	:
Telephone Number	:	918-758-3135

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/07/2013

1401 MORRIS DRIVE
OKMULGEE, OK
74447-6429

Practice Phone: 918-756-4233
Practice Fax: 918-756-5968