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General NPI Number Information
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NPI Number | 1750370268
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Entity Type | Organization
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Legal Business Name | GRADY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 2220 W IOWA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2738
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Country | US
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Telephone | 405-224-2300
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Fax | 405-779-2143
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Provider Business Mailing Address
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Address Line | 2220 W IOWA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2738
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Country | US
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Telephone | 405-224-2300
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Fax | 405-779-2143
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Authorized Official
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Title or Position | CEO
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Name | MR. WARREN KEAN SPELLMAN
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Credential |
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Telephone | 405-779-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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