Healthcare Provider Details

I. General information

NPI: 1275657017
Provider Name (Legal Business Name): CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N. BROADWAY
CARNEGIE OK
73015
US

IV. Provider business mailing address

PO BOX 97
CARNEGIE OK
73015
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 Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number102
License Number StateOK

VIII. Authorized Official

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