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General NPI Number Information
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NPI Number | 1356466817
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Entity Type | Organization
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Legal Business Name | COUNTY OF TILLMAN-CITY OF FREDERICK HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 319 E JOSEPHINE AVE
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City | FREDERICK
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State | OK
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Zip | 73542-2220
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Country | US
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Telephone | 580-335-7565
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Fax | 580-335-7329
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Provider Business Mailing Address
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Address Line | 319 E JOSEPHINE AVE
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City | FREDERICK
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State | OK
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Zip | 73542-2220
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Country | US
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Telephone | 580-335-7565
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Fax | 580-335-7329
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Authorized Official
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Title or Position | CFO
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Name | MRS. LISA HART
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Credential |
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Telephone | 580-335-7565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 2213
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License Number State | OK
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