Healthcare Provider Details

I. General information

NPI: 1770077554
Provider Name (Legal Business Name): SRP SAYRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 HOSPITAL DR
SAYRE OK
73662
US

IV. Provider business mailing address

911 HOSPITAL DR
SAYRE OK
73662-1206
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-9690
  • Fax:
Mailing address:
  • Phone: 580-323-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J CARTER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 918-413-6917