MEDICARE: SAYRE MEMORIAL HOSPITAL, INC.

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	207Q00000X	Family Medicine Physician	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	:	1447380480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAYRE MEMORIAL HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	911 HOSPITAL DRIVE
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1206
Country	:	US
Telephone Number	:	580-928-5541
Fax Number	:	580-928-3523

Provider Business Practice Location Address
First Line	:	911 HOSPITAL DRIVE
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1206
Country	:	US
Telephone Number	:	580-928-5541
Fax Number	:	580-928-3523

Authorized Official
Title or Position	:	CEO
Name	:	DONALD E BATES JR.
Credential	:
Telephone Number	:	580-928-5541

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	06/10/2015

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