Healthcare Provider Details

I. General information

NPI: 1083617807
Provider Name (Legal Business Name): NEWMAN MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S MAIN ST
SHATTUCK OK
73858
US

IV. Provider business mailing address

905 S MAIN ST
SHATTUCK OK
73858-9205
US

V. Phone/Fax

Practice location:
  • Phone: 580-938-2551
  • Fax: 580-938-2615
Mailing address:
  • Phone: 580-938-2551
  • Fax: 580-938-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2243
License Number StateOK

VIII. Authorized Official

Name: MR. EDDIE JACKSON MAJORS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 580-938-2551