Healthcare Provider Details

I. General information

NPI: 1922021146
Provider Name (Legal Business Name): GRADY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W IOWA AVE
CHICKASHA OK
73018-2738
US

IV. Provider business mailing address

2220 W IOWA AVE
CHICKASHA OK
73018-2738
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-2300
  • Fax: 405-779-2413
Mailing address:
  • Phone: 405-224-2300
  • Fax: 405-779-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: E. MICHAEL NUNAMAKER
Title or Position: CEO
Credential:
Phone: 405-224-2300