MEDICARE: SMH ACQUISITION,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	2207	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053381947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMH ACQUISITION,LLC

Provider Business Mailing Address
First Line	:	911 HOSPITAL DR
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1206
Country	:	US
Telephone Number	:	580-323-9692
Fax Number	:	580-323-9820

Provider Business Practice Location Address
First Line	:	911 HOSPITAL DR
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1206
Country	:	US
Telephone Number	:	580-323-9692
Fax Number	:	580-323-9820

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. ROBERT HICKS
Credential	:
Telephone Number	:	405-821-0435

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/10/2017

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