Healthcare Provider Details

I. General information

NPI: 1053997338
Provider Name (Legal Business Name): SOUTHERN PLAINS MEDICAL CENTER OF GARVIN COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VALLEY DR
PAULS VALLEY OK
73075-6613
US

IV. Provider business mailing address

100 VALLEY DR
PAULS VALLEY OK
73075-6613
US

V. Phone/Fax

Practice location:
  • Phone: 405-866-5100
  • Fax:
Mailing address:
  • Phone: 405-866-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MADHUKAR SHARMA
Title or Position: OWNER
Credential:
Phone: 904-238-3752