Healthcare Provider Details

I. General information

NPI: 1821554734
Provider Name (Legal Business Name): NEWMAN MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S MAIN ST
SHATTUCK OK
73858-9205
US

IV. Provider business mailing address

905 S MAIN ST
SHATTUCK OK
73858-9205
US

V. Phone/Fax

Practice location:
  • Phone: 580-938-5534
  • Fax:
Mailing address:
  • Phone: 580-938-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMARA NOBLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 580-938-2551