Healthcare Provider Details

I. General information

NPI: 1366427072
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 N MAY ST
GUYMON OK
73942-4457
US

IV. Provider business mailing address

520 MEDICAL DR
GUYMON OK
73942-4438
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-5730
  • Fax: 580-338-6115
Mailing address:
  • Phone: 580-338-5730
  • Fax: 580-338-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7120
License Number StateOK

VIII. Authorized Official

Name: TROY ZINN
Title or Position: CEO
Credential:
Phone: 580-338-3113