Healthcare Provider Details

I. General information

NPI: 1356466817
Provider Name (Legal Business Name): COUNTY OF TILLMAN-CITY OF FREDERICK HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/02/2012
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: 580-335-7565
  • Fax: 580-335-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2213
License Number StateOK

VIII. Authorized Official

Name: MRS. LISA HART
Title or Position: CFO
Credential:
Phone: 580-335-7565