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General NPI Number Information
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NPI Number | 1487631156
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Entity Type | Organization
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Legal Business Name | BEAVER COUNTY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 718 AVE. A
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City | BEAVER
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State | OK
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Zip | 73932-3101
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Country | US
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Telephone | 580-625-3477
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Fax | 580-625-3562
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | BEAVER
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State | OK
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Zip | 73932-0640
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Country | US
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Telephone | 580-625-3477
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Fax | 580-625-3562
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BRENT MEYERS
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Credential |
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Telephone | 580-625-4551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2242
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License Number State | OK
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