Healthcare Provider Details

I. General information

NPI: 1245391846
Provider Name (Legal Business Name): MEMORIAL HOSPITAL & PHYSICIAN GROUP HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E JOSEPHINE AVE
FREDERICK OK
73542-2220
US

IV. Provider business mailing address

319 E. JOSEPHINE AVE
FREDERICK OK
73542-2220
US

V. Phone/Fax

Practice location:
  • Phone: 580-335-7565
  • Fax: 580-335-7329
Mailing address:
  • Phone: 580-335-6631
  • Fax: 580-335-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7128
License Number StateOK

VIII. Authorized Official

Name: MRS. NATALIE ANN HILBURN
Title or Position: HOME HEALTH OFFICE MANAGER
Credential:
Phone: 580-335-6631