Healthcare Provider Details

I. General information

NPI: 1679550115
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: 12/27/2005
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E JOSEPHINE AVENUE
FREDERICK OK
73542-2220
US

IV. Provider business mailing address

319 E JOSEPHINE AVENUE
FREDERICK OK
73542-2220
US

V. Phone/Fax

Practice location:
  • Phone: 580-335-6600
  • Fax: 580-335-5044
Mailing address:
  • Phone: 580-335-6600
  • Fax: 580-335-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7103
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN D. ADE
Title or Position: BOARD CHAIRMAN
Credential: PT
Phone: 580-335-6642