Healthcare Provider Details

I. General information

NPI: 1114143252
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF TEXAS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL DRIVE
GUYMON OK
73942
US

IV. Provider business mailing address

HCR #4 BOX 80
GUYMON OK
73942
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-6515
  • Fax:
Mailing address:
  • Phone: 580-338-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberTA516
License Number StateOK

VIII. Authorized Official

Name: MRS. LYNETTE HELM
Title or Position: PHYSICAL THERAPIST ASSIST.
Credential: RPTA
Phone: 580-338-6515