Healthcare Provider Details

I. General information

NPI: 1790976538
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 N ROOSEVELT ST
GUYMON OK
73942-2729
US

IV. Provider business mailing address

520 MEDICAL DR
GUYMON OK
73942-4438
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-7792
  • Fax:
Mailing address:
  • Phone: 580-338-6515
  • Fax: 580-468-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2249
License Number StateOK

VIII. Authorized Official

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