Healthcare Provider Details

I. General information

NPI: 1407072390
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL DR
GUYMON OK
73942-4438
US

IV. Provider business mailing address

520 MEDICAL DR
GUYMON OK
73942-4438
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-3113
  • Fax: 580-468-3442
Mailing address:
  • Phone: 580-338-3113
  • Fax: 580-468-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2249
License Number StateOK

VIII. Authorized Official

Name: TRACY JOHNSON
Title or Position: CEO
Credential:
Phone: 580-338-6515