Healthcare Provider Details

I. General information

NPI: 1295735991
Provider Name (Legal Business Name): JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E CHESTNUT ST
HOLLIS OK
73550-2030
US

IV. Provider business mailing address

PO BOX 791
HOLLIS OK
73550-0791
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-3363
  • Fax: 580-688-9730
Mailing address:
  • Phone: 580-688-3363
  • Fax: 580-688-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2211
License Number StateOK

VIII. Authorized Official

Name: STEVE HARTGRAVES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 580-379-5500