Healthcare Provider Details

I. General information

NPI: 1578592788
Provider Name (Legal Business Name): GRADY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SOUTH RUSH AVE
RUSH SPRINGS OK
73082-0277
US

IV. Provider business mailing address

2220 W IOWA AVE
CHICKASHA OK
73018-2738
US

V. Phone/Fax

Practice location:
  • Phone: 580-476-2527
  • Fax: 580-476-3707
Mailing address:
  • Phone: 405-224-2300
  • Fax: 405-779-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WARREN KEAN SPELLMAN
Title or Position: CEO
Credential:
Phone: 405-779-2150