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General NPI Number Information
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NPI Number | 1760892921
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Entity Type | Organization
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Legal Business Name | PERRY MEMORIAL HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 1318 ELM ST
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City | PERRY
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State | OK
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Zip | 73077-5034
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Country | US
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Telephone | 580-336-9411
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Fax | 580-336-9422
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Provider Business Mailing Address
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Address Line | 501 N 14TH ST
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City | PERRY
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State | OK
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Zip | 73077-5021
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Country | US
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Telephone | 580-336-9411
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Fax | 580-336-9422
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Authorized Official
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Title or Position | BOARD CHAIRMAN
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Name | JOSEPH GREENLEE
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Credential |
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Telephone | 580-336-3541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2268
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License Number State | OK
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