=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043498108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERRY MEMORIAL HOSPITAL AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2008
-----------------------------------------------------
Last Update Date | 04/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 N 14TH ST
-----------------------------------------------------
City | PERRY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73077-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-336-3541
-----------------------------------------------------
Fax | 580-336-5801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 N 14TH ST
-----------------------------------------------------
City | PERRY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73077-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-336-3541
-----------------------------------------------------
Fax | 580-336-5801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JOE DUERR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-336-3541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7095
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------