Healthcare Provider Details

I. General information

NPI: 1043323447
Provider Name (Legal Business Name): CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NORTH BROADWAY
CARNEGIE OK
73015
US

IV. Provider business mailing address

PO BOX 97
CARNEGIE OK
73015-0097
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-1050
  • Fax: 580-654-2111
Mailing address:
  • Phone: 580-654-1050
  • Fax: 580-654-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number102
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2215
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. SHANE BRADLEY DUNNING
Title or Position: CEO
Credential:
Phone: 580-654-1050